Methylphenidate for attention deficit hyperactivity disorder and drug relapse in criminal offenders with substance dependence: a 24-week randomized placebo-controlled trial

Abstract

Aim: To test the efficacy and safety of osmotic release oral system (OROS) methylphenidate (MPH) in doses up to 180 mg/day to treat attention deficit hyperactivity disorder (ADHD) and prevent any drug relapse in individuals with a co-diagnosis of ADHD and amphetamine dependence.

Design: Randomized placebo-controlled 24-week double-blind trial with parallel groups design.

Setting: Participants were recruited from medium security prisons in Sweden. The medication started within 2 weeks before release from prison and continued in out-patient care with twice-weekly visits, including once-weekly cognitive behavioural therapy.

Participants: Fifty-four men with a mean age of 42 years, currently incarcerated, meeting DSM-IV criteria for ADHD and amphetamine dependence.

Measurements: Change in self-reported ADHD symptoms, relapse to any drug use (amphetamine and other drugs) measured by urine toxicology, retention to treatment, craving and time to relapse.

Findings: The MPH-treated group reduced their ADHD symptoms during the trial (P = 0.011) and had a significantly higher proportion of drug-negative urines compared with the placebo group (P = 0.047), including more amphetamine-negative urines (P = 0.019) and better retention to treatment (P=0.032).

Conclusions: Methylphenidate treatment reduces attention deficit hyperactivity disorder symptoms and the risk for relapse to substance use in criminal offenders with attention deficit hyperactivity disorder and substance dependence.

Keywords: ADHD; methylphenidate; pharmacotherapy; substance use.

Figure 1

Study profile. Methylphenidate for attention deficit hyperactivity disorder (ADHD) and drug relapse in criminal offenders with substance dependence: a 24-week randomized placebo-controlled trial

Figure 2

Change in self-rated attention deficit hyperactivity disorder (ADHD) symptoms (95% confidence interval = −13.78 to −1.91, P = 0.011)

Figure 3

Proportion of negative urine-toxicology after release from prison (weeks 3–24) for the two treatment groups; methylphenidate (MPH) and placebo over 24 weeks of treatment: (a) any drugs amphetamine + other drugs, mean difference 95% confidence interval (CI) = 0.05–0.32; (b) amphetamines only, mean difference 95% CI = 0.07–0.36; and (c) other drugs, mean difference 95% CI = 0.02–0.25

Figure 4

Kaplan–Meier curve for retention in treatment through to last visit at the clinic [methylphenidate (MPH): Md = 51, placebo: Md = 18; hazard ratio 0.38, 95% confidence interval = 0.174–0.647]