Psychiatric assessment of prisoners in opioid-maintenance treatment: emphasis on ADHD

Background: Attention-deficit hyperactivity disorder (ADHD) often coincides with substance abuse and delinquency and prisoners are at risk of suffering from both conditions. However, knowledge about ADHD and other psychiatric comorbidities, as well as prescription practice of psychopharmacologic medication and opioid-maintenance treatment (OMT) in inmates suffering from opioid use disorder is limited.

Methods: A sample of opioid-maintained inmates was assessed for psychiatric comorbidities including ADHD, substance abuse history, types of offense, and psychopharmacological treatment using a standardized battery of instruments (Adult ADHD self-report scale, Wender Utah Rating Scale, Mini International Neuropsychiatric Interview, European Addiction Severity Index). Prescribed medication was retrieved from inmates’ medical files.

Results: The final sample consisted of N=133 adult inmates (mean age 35.7y, 21.8% female) in OMT (41.4% methadone, mean dose 44.8mg/d; 25.6% levomethadone, mean dose 15mg/d; 18% SROM, mean dose 656.7mg/d; 15% buprenorphine, mean dose 6.3mg/d). Fifty percent screened positive for childhood and 17% for adult ADHD, four (3.1%) received ADHD medication (less than 10% of inmates who scored for adult ADHD). Inmates with ADHD symptom status were significantly younger at first use for the majority of substances, reported more drug overdoses, longer duration of cocaine and prescribed medication abuse and more in- and outpatient treatments (all p < .05). For all inmates in OMT, an elevated rate of psychiatric comorbidities was observed (78.9%). Prescription rate of psychopharmacologic medication was high, in particular for benzodiazepines (85% of the sample according to inmates’ files).

Conclusion: There is a particular need for standardized assessment of ADHD and other psychiatric comorbidities in OMT-prisoners at prison entry. Implementation of evidence-based treatment standards is required in order to prevent inadequate treatment attempts. Particular attention should be paid to adolescents with ADHD concerning initiation of substance use.