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Clinical trial of sustained release methylphenidate for Attention Deficit Hyperactivity Disorder (ADHD) in adult criminal offenders with amphetamine addiction
ISRCTN ISRCTN77940178
DOI 10.1186/ISRCTN77940178
ClinicalTrials.gov identifier
EudraCT number
Public title Clinical trial of sustained release methylphenidate for Attention Deficit Hyperactivity Disorder (ADHD) in adult criminal offenders with amphetamine addiction
Scientific title
Acronym N/A
Serial number at source MKJF001
Study hypothesis Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood condition that in many cases persists into adulthood. Approximately 1 - 2 % of the adult population is affected. ADHD is characterised by problems with attention, hyperactivity and impulsivity and leads to disabling difficulties in many areas of life. Additional psychiatric problems are common, abuse of drugs and alcohol being one of the most frequent. An estimated 30% of the individuals with substance use have ADHD. Amphetamine use is a major problem in Sweden and internationally. Many of amphetamine dependent individuals are also involved in criminal activity and relapse rate in criminality is very high for the abuse population. So far there is no evidence-based pharmacotherapy for amphetamine dependency. Few studies have addressed the question of treating ADHD with stimulants in substance dependent population.

Hypothesis:
Does sustained release methylphenidate combined with psychosocial treatment (relapse prevention) in amphetamine dependent individuals with ADHD significantly lower the risk for relapse to substance abuse compared with placebo and psychosocial treatment (relapse prevention)?
Lay summary Not provided at time of registration
Ethics approval Ethics approval received from the Regional Ethics Committee in Stockholm on the 12th June 2006 (ref: 2006/585-31/2). Amendment approved on the 27th September 2006 (ref: 2006/1103-32).
Study design Single-centre double-blind randomised placebo-controlled with parallel groups.
Countries of recruitment Sweden
Disease/condition/study domain Attention Deficit Hyperactivity Disorder (ADHD)
Participants - inclusion criteria 1. Male prison inmates
2. 18 to 65 years of age
3. Those who meet the Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV) criteria for amphetamine addiction and for ADHD
4. Those who, after release from prison, have an address and phone number in Stockholm area where they can be reached
Participants - exclusion criteria 1. Opioid, alcohol, cannabis or benzodiazepine addiction
2. Other serious psychiatric conditions apart from substance abuse/addiction (i.e. dementia, severe depression with suicidal ideation, acute psychotic symptoms, chronic schizophrenic syndrome)
3. Ongoing medication with benzodiazepines or neuroleptics
4. Acute symptoms of withdrawal regardless of substance
5. Known heart condition
6. History of stroke
7. Other severe medical condition (cancer, hypertension, glaucoma, advanced arteriosclerosis, liver cirrhosis or any medical condition that could mean a risk for the patient)
8. Known hypersensitivity to methylphenidate
Anticipated start date 12/04/2007
Anticipated end date 30/09/2011
Status of trial Completed
Patient information material
Target number of participants 54 (Recruitment complete as of 17/05/2011)
Interventions Please note that as of 18/11/10 the anticipated end date of this trial was extended from 30/06/2009 to 30/09/201.

Inmates who volunteer for the study are screened with the adult ADHD Self-Report Scale (ASRS) and Wender Utah Rating Scale (WURS) and the Structured Clinical Interview for DSM-IV (SCID-I) by a psychologist and a physician. Individuals who meet the study criteria undergo a neuropsychological assessment and baseline measurements are completed. Subjects also undergo a physical examination, checking their blood pressure; they also leave a urine specimen and a blood sample to test liver function and hepatitis. 14 days before their release they are included in the study given that they meet all the parameters required.

Subject are randomised into sustained release Methylphenidate (MPH) group or placebo group. The randomisation is handled by an independent pharmacist. Starting dose is 18 mg with 19-day titration to maximum dose of 180 mg. For patients who do not tolerate dose increase the dosage will be adjusted and continued at the tolerated level.

After their release subjects attend an out patient clinic twice a week and are seen by a research nurse. At each visit subjects collect the medication needed until next visit. They are also required to produce a urine specimen and fill in forms or take tests required for that visit. Once a week all subjects receive cognitive behaviour therapy (Relapse Prevention [RP]). RP starts at week 1 while subjects are still in prison and continues for 12 weeks. At weeks 13 - 24 subjects meet a psychologist/coach every fortnight for help in practical matters.
Primary outcome measure(s) Percentage of urine samples with no trace of drugs of abuse (amphetamines, opioids, benzodiazepines, delta-9-Tetrahydrocannabinol (THC), cocaine, dextropropoxifen, buprenorphine), analysed at week 12 and 24.
Secondary outcome measure(s) The following will be analysed at week 12 and 24:
1. Relapse to crime (readmission to prison or other legal action for criminal offence, self-reported criminality)
2. Self-reported reduction in ADHD-symptoms, assessed using the Conners' Adult ADHD Rating Scales (CAARS)
3. Reduction in psychiatric symptoms, assessed using Outcome Questionaire 45
4. Plasma concentration of methylphenidate
5. Clinician reported reduction in ADHD-symptoms (Clinical Global Impressions [CGI] scale)
6. Self-reported drug-craving measured on a Visual Analogue Scale (VAS)
7. Reduction of problems in attention assessed by Connors' Continuous Performance Test (CPT)
8. Self-reported drug use, assessed using the Addiction Severity Index (ASI) and time-line follow-back
9. Interpersonal Problems (IIP)
Sources of funding 1. Addiction Centre Stockholm (Beroendecentrum Stockholm) (Sweden)
2. National Psychiatric Services Coordination Taskgroup (Nationell Psykiatri Samordning) (Sweden)
Trial website
Publications
Contact name Dr  Johan  Franck
  Address Karolinska Institute
Department of Clinical Neurosciences
M4:02
  City/town Stockholm
  Zip/Postcode 17176
  Country Sweden
  Email johan.franck@ki.se
Sponsor Addiction Centre Stockholm (Beroendecentrum Stockholm) (Sweden)
  Address Box 11895
  City/town Stockholm
  Zip/Postcode 11895
  Country Sweden
  Email maija.konstenius@sll.se
  Sponsor website: http://www.beroendecentrum.com/
Date applied 03/09/2007
Last edited 07/09/2011
Date ISRCTN assigned 26/10/2007
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