News: General Press

Psychostymulant medication safe in adolescents with ADHD and substance use disorders

Source: MEDSCAPE / Date: December 18, 2009 / Category: General Press

Long-acting psychostimulant medication to treat adolescents with attention-deficit/hyperactivity disorder (ADHD) who have co-occurring substance use disorders (SUDs) appears to be safe even if the adolescents have not achieved abstinence.

Results of the recently completed large, multisite randomized controlled trial also indicate that long-acting psychostimulant medication for ADHD appears to carry a low risk of abuse or diversion liability in adolescents concurrently receiving outpatient drug treatment.

Presented at the American Academy of Child & Adolescent Psychiatry 56th Annual Meeting, investigators from the University of Colorado at Denver reported methylphenidate OROS (OROS-MPH) appears to have similar safety and tolerability in adolescents with SUDs as it does in children and adolescents with ADHD who do not have co-occurring SUDs.

According to the study's principal investigator, Paula Riggs, MD, ADHD often goes untreated in adolescents with substance abuse, and this has been associated with poorer treatment outcomes.

To evaluate the safety and efficacy of OROS-MPH plus cognitive behavioral therapy (CBT) compared with CBT plus placebo for the reduction of ADHD symptoms and substance use in adolescents, the researchers randomized 303 participants

Participants were aged 13 to 18 years, met Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for ADHD, and scored 22 or higher on the baseline ADHD symptom checklist.

Individuals in both treatment groups received weekly 50- to 60-minute, individual CBT. In addition, participants received OROS-MPH titrated to a maximum fixed dose of 72 mg/day or placebo.

Of the total study group 75% completed the trial. Overall, more than 90% of participants achieved the targeted daily dose of 72 mg. Medication compliance and CBT session attendance was 79% and 70%, respectively, with no differences in these outcomes between the 2 study groups.

The researchers also reported that despite nonabstinence in most participants OROS-MPH had an excellent safety profile with good tolerability.

The study showed a clinically and statistically significant reduction in ADHD symptoms in those treated with OROS-MPH plus CBT of 46%. However, there was no separation between the 2 treatment groups because of a similar 45% reduction in the placebo plus CBT treatment group based on the study's primary outcome measure of adolescent-reported ADHD symptoms.

However, parent ratings were lower with OROS-MPH compared with placebo at 8 weeks (P < .02) and 16 weeks (P < .0015). Adolescents treated with OROS-MPH plus CBT also reported significant improvement in their problem-solving ability (P < .0023) and focused coping skills (P < .023) compared with those treated with placebo plus CBT, who reported no change on these measures from baseline.

Similarly, there was a clinically and statistically significant reduction in the number of days of past-month drug use in both treatment groups but no difference between groups.

"I think that the most important clinical implications of this study may be that OROS-MPH, and possibly other long-acting psychostimulant medications, appears to be safe and well tolerated in nonabstinent adolescents who are concurrently enrolled in substance treatment and who receive regular safety and compliance monitoring, " said Dr. Riggs.

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