Stimulant medication for ADHD in opioid maintenance treatment.
OBJECTIVE
The use of central stimulant medication in adults with attention deficit hyperactivity disorder (ADHD) who receive opioid maintenance treatment remains controversial and empirical evidence is limited. Because of the abuse potential of stimulant drugs, Norway has restrictions on prescribing central stimulants to individuals who have substance use disorders or who are on opioid maintenance treatment. In this naturalistic study, we describe experiences from a program through which central stimulant medication was administered to patients with ADHD receiving opioid maintenance treatment.


METHODS
This report is based on a program evaluation of a combined treatment project designed to provide stimulant medication to patients with adult ADHD who were receiving opioid maintenance treatment. As part of the clinical treatment, patients were monitored closely for any medical issues or adverse medication reactions and provided regular urine samples for analysis and information regarding demographics, treatment goals, legal involvement, diagnoses, substance abuse, and ADHD symptoms. Monitoring occurred at baseline, at 2 months (after patients being stabilized on the central stimulant), and again at 3, 6 and 24 months.


RESULTS
Among 42 patients initially offered the combined treatment, 24 were actually eligible, 20 started the combined treatment, and 10 stayed in the program. We were not able to identify a single major cause of treatment dropout. Patients reported significantly fewer symptoms of ADHD at the 6- to 8-week point, regardless of whether the data were analyzed using an intent-to-treat (all participants) or per-protocol (only those with complete data at all points) method. Even though self-assessed ADHD scores dropped significantly during treatment, the scores still remained fairly high, suggesting persistent functional impairment. Neither severe complications nor increase in substance abuse were observed during treatment with central stimulants.


CONCLUSIONS
These findings show some promise with regard to the safety and utility of central stimulant medications for patients with ADHD who are receiving opioid maintenance treatment. Our study has methodological limitations, and systematic, well-designed clinical investigations are needed to increase the knowledge base.
a Department of Outpatient Addiction Recovery , Oslo University Hospital , Oslo , Norway.
Kristine Fiksdal
KF
Abel
Jørgen G
JG
Bramness
Egil W
EW
Martinsen
D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications* / Q000517:prevention & control*; D000697:Central Nervous System Stimulants / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000150:complications* / Q000517:prevention & control*; D010349:Patient Compliance
D000697:Central Nervous System Stimulants
ADHD; drug dependence; methylphenidate treatment; opioid maintenance treatment