title: Similar and Different? Subjective Effects of Methylphenidate and Cocaine in Opioid-Maintained Patients.
abstract: Methylphenidate (MPH) is commonly prescribed for attention deficit hyperactivity disorder (ADHD). Recreational nonmedical use has been described and also occurs in patients on opioid maintenance treatment (OMT). MPH has been proposed for use as replacement therapy in cocaine dependence, although evidence for efficacy is inconclusive. We conducted a cross-sectional interview study on patterns of MPH use in a sample of 20 MPH-using patients on OMT with a history of cocaine use. We assessed symptoms of depression, ADHD during childhood, and retrospective subjective-effects profiles of MPH and cocaine. Risky patterns of MPH use were common, in particular illicit acquisition, use of high doses, and parenteral administration. Sixty percent of patients reported having used MPH as a substitute for cocaine. Correspondingly, the subjective-effect profiles of MPH and cocaine showed striking parallels, with overall effects of MPH being rated more positively than those of cocaine. Proportions of patients with elevated scores for depression or childhood ADHD were large, highlighting the importance of treating dual disorders in this population. Clinical studies on MPH substitution in cocaine-dependent patients on opioid maintenance treatment could benefit from consideration of the patterns of application of MPH in this population. Results are preliminary due to small sample size.
authors.affiliation: a Senior Physician, Division of Substance Use Disorders , Psychiatric Hospital of the University of Basel , Basel , Switzerland.
authors.forename: Marc
authors.initials: M
authors.lastname: Vogel
authors.affiliation: b Pharmacist, Division of Clinical Pharmacology , University Hospital of Basel and University of Basel , Basel , Switzerland.
authors.forename: Patricia
authors.initials: P
authors.lastname: Bucher
authors.affiliation: a Senior Physician, Division of Substance Use Disorders , Psychiatric Hospital of the University of Basel , Basel , Switzerland.
authors.forename: Johannes
authors.initials: J
authors.lastname: Strasser
authors.affiliation: c Professor, Division of Clinical Pharmacology , University Hospital of Basel and University of Basel , Basel , Switzerland.
authors.forename: Matthias E
authors.initials: ME
authors.lastname: Liechti
authors.affiliation: c Professor, Division of Clinical Pharmacology , University Hospital of Basel and University of Basel , Basel , Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Krähenbühl
authors.affiliation: d Senior Psychologist, Division of Substance Use Disorders , Psychiatric Hospital of the University of Basel , Basel , Switzerland.
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Dürsteler
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology; D000697:Central Nervous System Stimulants / Q000008:administration & dosage / Q000009:adverse effects; D003042:Cocaine / Q000008:administration & dosage* / Q000009:adverse effects; D019970:Cocaine-Related Disorders / Q000534:rehabilitation*; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology; D017831:Diagnosis, Dual (Psychiatry); D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008774:Methylphenidate / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000379:methods; D009293:Opioid-Related Disorders / Q000534:rehabilitation*
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate; D003042:Cocaine
keywords: ADHD; polysubstance use; stimulants; subjective effects; substitution