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ADHD & Opioid Use Disorder: Understanding the Connection

June 24, 2022

Table of Contents

Attention deficit hyperactivity disorder (ADHD) and opioid use disorders sometimes occur together in the same individual. Researchers say more than 16% of people with ADHD treated by stimulants also use opioids, compared to 13% of people who don't use stimulant therapies.[1] The issue is troubling, and unfortunately, it's becoming increasingly common. Between 2007 and 2017, researchers saw a threefold increase in people with both opioid use disorder (OUD) and ADHD.[2] 

OUDs and ADHD share common symptoms, making diagnosis difficult. Some people struggle for years before obtaining a proper diagnosis. But when they do, they can enter treatment programs that can help.

Reasons Why People With ADHD Develop OUD 

ADHD is a condition in which an individual has both periods of inattention accompanied by hyperactivity. As a result, these individuals can struggle to achieve in multiple settings - at home, in school, etc. This can lead to depression, anxiety, and chronic stress that can be “self treated” with substances like opioids. [4]. 

Overlapping Symptoms of ADHD & OUD 

The sooner both ADHD and OUD are detected, the easier they are  to treat. But ADHD and OUD can look very similar because they have similar behaviors and features. At the same time, OUD can exacerbate the symptoms of ADHD and vice versa. 

These are just a few of the symptoms that might be experienced by an individual with both conditions:

Poor Concentration

People with ADHD may feel like their thoughts fly by at such a rapid pace that they can't keep up with them. They find focusing on just one task or thought process very difficult. 

People with opioid use disorders are often thinking about getting or using drugs. All other thoughts, plans, and dreams come second. They may seem distracted and unable to concentrate as they think about drugs. 

Impulsivity

People with ADHD act on their impulses quickly, often without thinking about them. An inability to concentrate and focus leaves them vulnerable to rash acts that they may regret later. 

People with OUDs can be impulsive either while high or in their decision making in attempts to obtain more of the drug.

Poor Social Connections 

People with ADHD may have trouble forming social connections when their behavior is erratic. People with opioid use disorders may also exhibit frustrating or angering behaviors toward those they love, impairing their social relationships with friends and family. 

Disorganization

People with ADHD struggle to stay on task, be productive, and complete their daily activities. People with OUDs may display similar traits due to drug use. 

Mood Swings 

ADHD is characterized by co-occurring development of anxiety, depression, and mood swings. Chemical changes associated with drug use in people with OUD may also predispose them to mood swings. 

Treatment for ADHD & OUD 

Medications remain the first line treatment for both ADHD and OUD. Stimulant medications - specifically adderall, ritalin, along with several others, help to calm overactive brain cells and improve the symptoms of ADHD. At the same time, first line treatments for OUD are pharmacological, and include medications like Suboxone and methadone. 

Studies show that few people on Medication for Addiction Treatment (MAT) for OUD get proper concurrent treatment for ADHD. [6] This is probably because the underlying conditions that drove the person to develop an OUD - ADHD itself - may not be recognized or adequately treated. Until the underlying ADHD is treated, the OUD may be harder or even impossible to treat.  

In addition, a person with both conditions may need to be on both stimulants and MAT simultaneously. While it is certainly possible and safe to be on both medications, these medications can potentially interact and cause side effects. Therefore, it is very important for anybody being treated for both OUD and ADHD simultaneously to have good support from a team of clinicians - particularly a team that is well versed in treating both OUD and ADHD. 

Nonpharmacologic Treatment for ADHD and OUD 

Therapy and behavioral support are extremely helpful in people with ADHD and OUD, and may be as important if not more important than pharmacologic therapy alone. [6]. 

Therapeutic programs that treat both problems at once are more likely to be successful than programs that focus on only one issue at a time. 

If you have both ADHD and OUD, talk to your doctor about the best treatments available for you. 

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Opioid Use Rising in ADHD Patients on Stimulants. Medpage Today. https://www.medpagetoday.com/psychiatry/adhd-add/74520. August 2018. Accessed May 2022. 
  2. Is Prescribing Stimulants OK for Comorbid Opioid Use Disorder, ADHD? Medscape. https://www.medscape.com/viewarticle/964908. December 2021. Accessed May 2022. 
  3. Prevalence of and Factors Associated with Long-Term Concurrent Use of Stimulants and Opioids Among Adults with Attention-Deficit/Hyperactivity Disorder. JAMA. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2696508?. 2018. Accessed May 2022. 
  4. Study Suggests Screening Patients with Fibromyalgia Syndrome for ADHD. AJMC. https://www.ajmc.com/view/study-suggests-screening-patients-with-fibromyalgia-syndrome-for-adhd-. December 2017. Accessed May 2022. 
  5. Long Wait Times, Provider Shortages Hinder ADHD Diagnosis. Northwest Public Broadcasting. https://www.nwpb.org/2022/04/14/long-wait-times-provider-shortages-hinder-adhd-diagnosis/. April 2022. Accessed May 2022. 
  6. Dispensation of Attention Deficit Hyperactivity Disorder (ADHD) Medications in Patients Receiving Opioid Agonist Therapy: A National Prospective Cohort Study in Norway from 2015 to 2017. BMC Psychiatry. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-020-02526-y. March 2020. Accessed May 2022. 

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