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
Abstract Background It is estimated that up to a third of patients on opioid agonist therapy (OAT) have attention deficit hyperactivity disorder (ADHD). Treatment by ADHD medication, including a centrally acting stimulant (CAS) or atomoxetine is one of the essential approaches. This study evaluates...
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| Format: | Article |
| Language: | English |
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BMC
2020-03-01
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| Series: | BMC Psychiatry |
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| Online Access: | http://link.springer.com/article/10.1186/s12888-020-02526-y |
| _version_ | 1811286587510620160 |
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| author | Jørn Henrik Vold Christer Aas Svetlana Skurtveit Ingvild Odsbu Fatemeh Chalabianloo Anne Halmøy Kjell Arne Johansson Lars Thore Fadnes |
| author_facet | Jørn Henrik Vold Christer Aas Svetlana Skurtveit Ingvild Odsbu Fatemeh Chalabianloo Anne Halmøy Kjell Arne Johansson Lars Thore Fadnes |
| author_sort | Jørn Henrik Vold |
| collection | DOAJ |
| description | Abstract Background It is estimated that up to a third of patients on opioid agonist therapy (OAT) have attention deficit hyperactivity disorder (ADHD). Treatment by ADHD medication, including a centrally acting stimulant (CAS) or atomoxetine is one of the essential approaches. This study evaluates the use of dispensed ADHD medications in the Norwegian OAT population in the period from 2015 to 2017. Types and doses of ADHD medications, co-dispensations of other potentially addictive drugs like benzodiazepines, z-hypnotics, gabapentinoids, and non-OAT opioids, as well as direct-acting antivirals (DAA) against hepatitis C infection, are investigated. Methods Information about all dispensed ADHD medication, OAT opioids, and the defined potentially addictive drugs were recorded from the Norwegian Prescription Database. Dispensation rates, the types, and the doses of dispensed ADHD medications were estimated by summarizing the number of dispensations, and the dispensed doses. Logistic regression analyses were employed to assess the associations between ADHD medication, and OAT opioid use, and dispensations of other potentially addictive drugs and DAAs against hepatitis C infection. Results A total of 9235 OAT patients were included. The proportion of patients who were dispensed ADHD medication increased from 3.5 to 4.6% throughout the study period. The three most dispensed CAS were short- and intermediate-acting methylphenidate (55%), lisdexamphetamine (24%), and dexamphetamine (17%) in 2017. Buprenorphine, rather than methadone, as OAT opioid (adjusted odds ratio: 1.6, CI: 1.2–2.1) was associated with being dispensed ADHD medication. Among patients who received CAS and OAT opioids each calendar year, the dispensed doses of methylphenidate increased from 63 mg/day in 2015 to 76 mg/day in 2017 (p = 0.01). Sixty percent of patients receiving ADHD medications were also dispensed other addictive drugs concomitantly in 2017. Similar results were found in 2015 and 2016. Conclusion Co-prescription of ADHD medications was low among patients on OAT in Norway, considering a high prevalence of ADHD in this patient group. On the other hand, concurrent dispensations of multiple addictive drugs were common in this population. Understanding the underlying reasons for such prescribing is essential, and research on how to optimize ADHD medication of patients with ADHD receiving OAT is needed. |
| first_indexed | 2024-04-13T03:02:34Z |
| format | Article |
| id | doaj.art-ed9efb24d3aa44c7a10fc2667196622b |
| institution | Directory Open Access Journal |
| issn | 1471-244X |
| language | English |
| last_indexed | 2024-04-13T03:02:34Z |
| publishDate | 2020-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Psychiatry |
| spelling | doaj.art-ed9efb24d3aa44c7a10fc2667196622b2022-12-22T03:05:23ZengBMCBMC Psychiatry1471-244X2020-03-0120111210.1186/s12888-020-02526-yDispensation of attention deficit hyperactivity disorder (ADHD) medications in patients receiving opioid agonist therapy; a national prospective cohort study in Norway from 2015 to 2017Jørn Henrik Vold0Christer Aas1Svetlana Skurtveit2Ingvild Odsbu3Fatemeh Chalabianloo4Anne Halmøy5Kjell Arne Johansson6Lars Thore Fadnes7Department of Addiction Medicine, Haukeland University HospitalDepartment of Addiction Medicine, Haukeland University HospitalDepartment of Mental Disorders, Norwegian Institute of Public HealthDepartment of Medicine, Karolinska InstitutetDepartment of Addiction Medicine, Haukeland University HospitalDivision of Psychiatry, Haukeland University HospitalDepartment of Addiction Medicine, Haukeland University HospitalDepartment of Addiction Medicine, Haukeland University HospitalAbstract Background It is estimated that up to a third of patients on opioid agonist therapy (OAT) have attention deficit hyperactivity disorder (ADHD). Treatment by ADHD medication, including a centrally acting stimulant (CAS) or atomoxetine is one of the essential approaches. This study evaluates the use of dispensed ADHD medications in the Norwegian OAT population in the period from 2015 to 2017. Types and doses of ADHD medications, co-dispensations of other potentially addictive drugs like benzodiazepines, z-hypnotics, gabapentinoids, and non-OAT opioids, as well as direct-acting antivirals (DAA) against hepatitis C infection, are investigated. Methods Information about all dispensed ADHD medication, OAT opioids, and the defined potentially addictive drugs were recorded from the Norwegian Prescription Database. Dispensation rates, the types, and the doses of dispensed ADHD medications were estimated by summarizing the number of dispensations, and the dispensed doses. Logistic regression analyses were employed to assess the associations between ADHD medication, and OAT opioid use, and dispensations of other potentially addictive drugs and DAAs against hepatitis C infection. Results A total of 9235 OAT patients were included. The proportion of patients who were dispensed ADHD medication increased from 3.5 to 4.6% throughout the study period. The three most dispensed CAS were short- and intermediate-acting methylphenidate (55%), lisdexamphetamine (24%), and dexamphetamine (17%) in 2017. Buprenorphine, rather than methadone, as OAT opioid (adjusted odds ratio: 1.6, CI: 1.2–2.1) was associated with being dispensed ADHD medication. Among patients who received CAS and OAT opioids each calendar year, the dispensed doses of methylphenidate increased from 63 mg/day in 2015 to 76 mg/day in 2017 (p = 0.01). Sixty percent of patients receiving ADHD medications were also dispensed other addictive drugs concomitantly in 2017. Similar results were found in 2015 and 2016. Conclusion Co-prescription of ADHD medications was low among patients on OAT in Norway, considering a high prevalence of ADHD in this patient group. On the other hand, concurrent dispensations of multiple addictive drugs were common in this population. Understanding the underlying reasons for such prescribing is essential, and research on how to optimize ADHD medication of patients with ADHD receiving OAT is needed.http://link.springer.com/article/10.1186/s12888-020-02526-yOpioid substitution treatmentCentrally acting stimulantsHyperkinetic disorderAttention deficit hyperactivity disorderSubstance-related disordersDispensed drugs |
| spellingShingle | Jørn Henrik Vold Christer Aas Svetlana Skurtveit Ingvild Odsbu Fatemeh Chalabianloo Anne Halmøy Kjell Arne Johansson Lars Thore Fadnes 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 Opioid substitution treatment Centrally acting stimulants Hyperkinetic disorder Attention deficit hyperactivity disorder Substance-related disorders Dispensed drugs |
| title | 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 |
| title_full | 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 |
| title_fullStr | 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 |
| title_full_unstemmed | 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 |
| title_short | 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 |
| title_sort | 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 |
| topic | Opioid substitution treatment Centrally acting stimulants Hyperkinetic disorder Attention deficit hyperactivity disorder Substance-related disorders Dispensed drugs |
| url | http://link.springer.com/article/10.1186/s12888-020-02526-y |
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