Attention deficit hyperactivity disorder (ADHD) frequently intersects with opioid use disorders (OUD). The reasons are complex.
Researchers say people with ADHD often struggle with pain, and they’re more prone to accidents and injuries treated with painkillers. The impulsivity associated with ADHD could make an opioid prescription even more dangerous.[4]
Some adults with ADHD are treated with stimulants, which they combine with their OUD therapies. For example, researchers say among all people enrolled in a Medication for Addiction Treatment (MAT) program for OUD, nearly 11% got at least one prescription for a stimulant drug for ADHD.[1]
If you have ADHD and OUD, treatment can help you feel better and rebuild your life. However, you should talk with your doctor about the risks and benefits of combining your medications.
Stimulant medications used for ADHD and weak opioids used for OUD can interact and cause serious health problems. Researchers say these combinations can lead to life-threatening cardiac problems.[7] Never take these medications together without checking with a doctor first.
Between 2007 and 2017, researchers saw a threefold increase in people with both OUD and ADHD.[2]
Researchers say that more people are being identified with ADHD due to a growing recognition of the problem and a push to offer appropriate care.[2]
At the same time, the United States is in the grip of an opioid epidemic. In 2021, over 75% of drug overdose deaths involved an opioid.[8] As doctors work to curb the death rates, they diagnose OUD more often and encourage their patients to get care.
Addictions don't develop accidentally. A combination of habits, decisions and vulnerabilities combine and allow problems to blossom. Researchers say people with ADHD typically develop OUD due to one of these factors:
Opioids like Vicodin and heroin boost pleasure signals in the brain, delivering a sensation of intense happiness and comfort. Stimulant medications like Ritalin work on the same pleasure signals.
A person combining stimulants and opioids doubles down on dopamine, and the result is an intense high that's hard to forget.[3] Some people are so enamored of the original high that they'll spend the rest of their lives trying to recreate it.
Some people dabble in opioids because they know the drugs will make them high. But others take the drug for purely medicinal reasons, and they get high anyway, starting the misuse cycle.
Chronic pain conditions like fibromyalgia are common in people with ADHD.[4] Some doctors treat these issues with strong painkillers like OxyContin.
Someone like this starts using opioids to help with a very real pain problem. But in time, the person begins to take the drug in unusual or unsafe ways. The person might do the following:
For someone like this, a pain problem started the misuse cycle.
People with ADHD move quickly, and they are often inattentive. Speed and distraction add to accident risks.[3] Cuts, muscle tears and broken bones are incredibly painful, and doctors often treat these issues with painkillers. The person may start medications to address the discomfort, but OUD blossoms in time.
It's not easy to attain a formal diagnosis for ADHD. In some parts of the country (like Washington State), people wait a year or longer to meet with a professional and begin a treatment program.[5]
As they wait, people with ADHD look for ways to calm their overactive minds and keep their impulses in check. Opioids may seem like an ideal solution, as these drugs are sedating and bring a sense of well-being. To a person under extreme stress, the pills may seem helpful.
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:
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.
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.
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.
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.
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.
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. These medications can potentially interact and cause side effects.[7] 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.
Therapy and behavioral support are extremely helpful in people with ADHD and OUD. 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.
Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role of the brain dopamine system in substance use disorders and in aging. He also studies brain function in obesity and eating disorders.
