Methylphenidate substitution for methamphetamine addiction and implications for future randomized clinical trials: a unique case series

Minařík, Jakub; Gabrhelík, Roman; Malcolm, Robert; Pavlovská, Amalie; Miller, Peter M.

doi:10.3109/14659891.2015.1045047

Cited by 9 publications

(5 citation statements)

References 16 publications

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“…This difference may be attributed to the type of substance, represented in the Czech Republic mainly by methamphetamine. Those with ADHD are more prone to using stimulants [39], and the stimulating effects of self-medicated methamphetamine (e.g., elevated concentration) may have the desired effects on ADHD symptoms [40, 41]. In addition, this 2-fold prevalence may also be explained by the population of drug users who are treated in TCs.…”

Section: Discussionmentioning

confidence: 99%

Attention Deficit Hyperactivity Disorder among Clients Diagnosed with a Substance Use Disorder in the Therapeutic Communities: Prevalence and Psychiatric Comorbidity

Miovský¹,

Lukavská²,

Rubášová³

et al. 2020

Eur Addict Res

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Background: Most severe substance use disorders (SUDs) are connected with attention deficit hyperactivity disorder (ADHD) and other mental health problems. Therapeutic communities (TCs) provide a suitable option for the treatment of severe SUDs. The relationship between ADHD, the severity of the SUD, and other comorbidities in residential TCs is unknown. Objective: To estimate the prevalence of ADHD among clients with an SUD in residential rehab, and to compare the mental health of clients with and without ADHD. Methods: A cohort study was conducted in 5 residential TCs (N = 180, 76.7% male, 53.9% 25–34 years, 79.2% diagnosed with methamphetamine use disorder). We assessed ADHD symptoms, substance use, mental health problems, and psychiatric symptoms. Results: ADHD was found in 51% of the clients who showed significantly higher scores for their psychiatric status composite score (ASI-PSY) (F = 9.08, p < 0.001; t = 5.05, p < 0.001), the positive psychiatric symptoms total (SCL-PST) (F = 3.36, p < 0.05; t = 3.15, p < 0.01), and the global severity index (SCL-GSI) (F = 3.27, p < 0.05; t = 3.18, p < 0.01). The ASI-PSY and SCL correlated significantly with the symptoms of attention deficit disorder (Pearson’s r’s = 0.30–0.42, p’s < 0.001) and the symptoms of hyperactivity disorder (r’s = 0.24–0.30, p’s < 0.01). Even when severity of substance use was accounted for, ADHD was confirmed as a significant predictor of ASI-PSY (B= 0.14, p < 0.001 for combined disorder; B = 0.20, p < 0.001 for attention disorder) and partially of SCL-PST (B = 8.12, p < 0.05 for attention disorder). Conclusions: The ADHD prevalence in TCs was nearly 10-fold compared to the globally recorded values. ADHD diagnostic procedures and interventions should become an integral part of the standard diagnostic and treatment process.

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Section: Discussionmentioning

confidence: 99%

Attention Deficit Hyperactivity Disorder among Clients Diagnosed with a Substance Use Disorder in the Therapeutic Communities: Prevalence and Psychiatric Comorbidity

Miovský¹,

Lukavská²,

Rubášová³

et al. 2020

Eur Addict Res

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“…To reduce the problem of polysubstance use, women hospitalized with 2 or more diagnoses related to different psychoactive substances (F10–F18) or women who were hospitalized for polydrug use (F19) during pregnancy/study period were excluded. In this paper, we refer to women with an ICD-10 F15 diagnosis as “women using MA” since this diagnostic group is nearly exclusively represented by MA in the Czech Republic [32, 33]. The newborns of women using MA during pregnancy are referred to as “MA-exposed.” There were no women with >1 pregnancy in the MA group.…”

Section: Methodsmentioning

confidence: 99%

Prenatal Methamphetamine Exposure and Adverse Neonatal Outcomes: A Nationwide Cohort Study

et al. 2020

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Background: There is limited knowledge on the adverse outcomes in newborns after maternal methamphetamine (MA) use during pregnancy. Objectives: To compare neonatal outcomes in newborns exposed to MA with the newborns of opioid-exposed mothers and of mothers from the general population (GP). Method: A cohort study using nationwide registries in Czechia (2000–2014). Women hospitalized with a main diagnosis of MA use disorder during pregnancy (n = 258) and their newborns were defined as MA-exposed. The comparison groups consisted of women (n = 199) diagnosed with opioid use disorder during pregnancy, defined as opioid-exposed, and women (n = 1,511,310) with no substance use disorder diagnosis (GP). The neonatal outcomes studied were growth parameters, gestational age, preterm birth, and Apgar score. To explore the associations between MA exposure and neonatal outcomes, regression coefficients (b) and odds ratios from multivariable linear and binary logistic regression were estimated. Results: MA-exposed women had similar socio-economic characteristics to opioid-exposed, both of which were worse than in the GP. After adjustment, MA exposure was associated with a more favourable birthweight when compared to the opioid-exposed (adjusted mean differences [aMD] b = 122.3 g, 95% CI: 26.0–218.5) and length (aMD b = 0.6 cm, 0.0–1.1). Unadjusted results from the comparison with the GP showed that the MA group had poorer neonatal outcomes, especially in the growth parameters. Adjustment for background characteristics had a profound effect on the comparison with the GP. After adjustment, MA exposure was associated only with a slightly reduced birthweight (aMD b = −63.0 g, −123.0 to −3.1) and birth length (aMD b = −0.3 cm, −0.6 to 0.0). Conclusions: Although the observed negative outcomes were large in the MA-exposed newborns, the adjustment had a profound effect on the comparison with the GP, indicating the large influence of lifestyle and socio-economic factors in these high-risk pregnancies. MA-exposed newborns had better neonatal outcomes compared to opioids-exposed.

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“…So far, studies have demonstrated limited benefits for drugs such as methylphenidate, bupropion, modafinil and naltrexone [ 66 ]. Pilots using prescription psychostimulants for methamphetamine dependence are in place in Czech Republic [ 67 ], and further research is needed to confirm benefits.…”

Section: Discussionmentioning

confidence: 99%

Different phases of ATS use call for different interventions: a large qualitative study in Europe

Liebregts

Rigoni²,

Petruželka

et al. 2022

Harm Reduct J

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Background Amphetamine-type stimulants (ATS) are globally widely used. Scientific literature generally defines four phases of substance use (initiation, continuation, increase and decrease); however, there is limited understanding of what influences these different phases of ATS use. The ATTUNE study investigated which factors shape individual phases of use, or ATS use patterns. In this article, we report on these phases into and out of ATS use, and propose a set of recommendations for prevention, harm reduction and treatment of the different phases of ATS use. Methods Qualitative, semi-structured interviews (n = 237) were conducted in five different European countries with participants who had used ATS, varying from a few times in a lifetime to daily. Results Amphetamine and MDMA were the most commonly used ATS. Yet, types of ATS used differed between the countries. We found that people who use ATS have various motives for and dynamic patterns of ATS use with alternating phases of increase, continuation, decrease and sometimes dependence. Cessation was pursued in different ways and for diverse reasons, such as mental health problems and maturing out. Availability seemed not an issue, regardless of the type of ATS, phase or country. Conclusions These findings demonstrate that tailor-made interventions are needed for the diverse types of people who use ATS and different phases or patterns of ATS use, to reduce possible harms of use. We recommended a set of interventions for the different ATS phases. These include drug checking services, peer-led information, self-management of ATS use, mental health support to help people cope with stressful life events and prevent uncontrolled use, and follow-up support after treatment.

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Methylphenidate substitution for methamphetamine addiction and implications for future randomized clinical trials: a unique case series

Cited by 9 publications

References 16 publications

Attention Deficit Hyperactivity Disorder among Clients Diagnosed with a Substance Use Disorder in the Therapeutic Communities: Prevalence and Psychiatric Comorbidity

Attention Deficit Hyperactivity Disorder among Clients Diagnosed with a Substance Use Disorder in the Therapeutic Communities: Prevalence and Psychiatric Comorbidity

Prenatal Methamphetamine Exposure and Adverse Neonatal Outcomes: A Nationwide Cohort Study

Different phases of ATS use call for different interventions: a large qualitative study in Europe

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