Conduct disorder and attention-deficit/hyperactivity disorder as risk factors for prescription opioid use

Christine M Wickens; Audrey Kao; Anca R Ialomiteanu; Karina Dubrovskaya; Calvin Kenney; Evelyn Vingilis; Patricia Erickson; Nathan J Kolla; Gina Stoduto; David Soule; Robert E Mann

doi:10.1016/j.drugalcdep.2020.108103

Conduct disorder and attention-deficit/hyperactivity disorder as risk factors for prescription opioid use

Drug Alcohol Depend. 2020 Aug 1:213:108103. doi: 10.1016/j.drugalcdep.2020.108103. Epub 2020 Jun 10.

Authors

Affiliations

¹ Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, 33 Russell Street, Toronto, Ontario, M5S 2S1, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, 250 College Street, Toronto, M5T 1R8, Ontario, Canada; University of Toronto, Dalla Lana School of Public Health, 155 College Street, Toronto, Ontario, M5T 3M7, Canada; University of Toronto, Institute for Health Policy, Management and Evaluation, 425-155 College Street, Toronto, Ontario, M5T 1P8, Canada. Electronic address: Christine.Wickens@camh.ca.
² Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, 33 Russell Street, Toronto, Ontario, M5S 2S1, Canada.
³ Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, 33 Russell Street, Toronto, Ontario, M5S 2S1, Canada; Harvard University, Cambridge, MA, 02138, USA.
⁴ Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, 33 Russell Street, Toronto, Ontario, M5S 2S1, Canada; Humber College, 2 Colonel Samuel Smith Park Drive, Toronto, Ontario, M8V 4B6, Canada.
⁵ Western University, Schulich School of Medicine and Dentistry, 1151 Richmond Street North, London, Ontario, N6A 5C1, Canada.
⁶ University of Toronto, Department of Sociology, 725 Spadina Avenue, Toronto, Ontario, M5S 2J4, Canada; University of Toronto, Centre for Criminology and Sociolegal Studies, 14 Queen's Park Crescent West, Toronto, Ontario, M5S 3K9, Canada.
⁷ Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, 250 College Street, Toronto, M5T 1R8, Ontario, Canada; University of Toronto, Centre for Criminology and Sociolegal Studies, 14 Queen's Park Crescent West, Toronto, Ontario, M5S 3K9, Canada; Centre for Addiction and Mental Health, Violence Prevention Neurobiological Research Unit, 250 College Street, Toronto, Ontario, M5T 1R8, Canada; Waypoint Centre for Mental Health Care, 500 Church Street, Penetanguishene, Ontario, L9M 1G3, Canada.
⁸ Centre for Addiction and Mental Health, Institute for Mental Health Policy Research, 33 Russell Street, Toronto, Ontario, M5S 2S1, Canada; Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, 250 College Street, Toronto, M5T 1R8, Ontario, Canada; University of Toronto, Dalla Lana School of Public Health, 155 College Street, Toronto, Ontario, M5T 3M7, Canada.

PMID: 32559668
DOI: 10.1016/j.drugalcdep.2020.108103

Abstract

Background: Existing studies of attention deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and substance use or substance use disorders have produced mixed results, with some identifying a direct link between ADHD and general or disordered substance use and others suggesting that comorbid CD may explain this relationship. Insufficient research has addressed the issue, which is particularly relevant in the context of the opioid crisis. This study examined the association of probable ADHD and childhood CD with self-reported opioid use in a general-population sample.

Method: The 2011-2013 cycles of the CAMH Monitor, a cross-sectional survey of adults (18+ years) from Ontario, Canada provided data from 6074 respondents. Binary logistic regressions were conducted of self-reported medical, non-medical, and any prescription opioid use in the previous 12 months, assessing demographic characteristics, perceived physical and mental health, and probable ADHD, childhood (before age 15 years) symptoms of CD, or their combination.

Results: Adjusting for potential covariates, probable ADHD alone was not associated with prescription opioid use. Childhood symptoms of CD significantly predicted non-medical use (OR = 2.10, 95% CI = 1.10, 4.03). ADHD and CD symptoms combined significantly predicted medical (OR = 3.27, 95% CI = 1.20, 8.91), non-medical (OR = 4.73, 95% CI = 1.05, 21.30), and any (OR = 3.02, 95% CI = 1.13, 8.11) prescription opioid use, although a low base rate of non-medical use may have negatively affected model fit.

Conclusions: Previous findings relating ADHD to opioid use could be explained, in part, by the high rate of comorbidity between ADHD and CD. These data support prevention and treatment programs targeting individuals with comorbid ADHD and CD symptoms.

Keywords: Attention deficit hyperactivity disorder; Conduct disorder; Prescription opioids.