Winhusen Theresa M, Lewis Daniel F, Riggs Paula D, Davies Robert D, Adler Lenard A, Sonne Susan, Somoza Eugene C
Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, Ohio 45220, USA.
J Child Adolesc Psychopharmacol. 2011 Oct;21(5):455-63. doi: 10.1089/cap.2011.0014.
Psychostimulants are effective treatments for attention-deficit/hyperactivity disorder (ADHD) but may be associated with euphoric effects, misuse/diversion, and adverse effects. These risks are perceived by some clinicians to be greater in substance-abusing adolescents relative to non-substance-abusing adults. The present study evaluates the subjective effects, misuse/diversion, and adverse effects associated with the use of osmotic-release oral system methylphenidate (OROS-MPH), relative to placebo, for treating ADHD in adolescents with a substance use disorder (SUD) as a function of substance use severity and compared these risks with those associated with the treatment of ADHD in adults without a non-nicotine SUD.
Datasets from two randomized placebo-controlled trials of OROS-MPH for treating ADHD, one conducted with 303 adolescents (13-18) with at least one non-nicotine SUD and one with 255 adult smokers (18-55), were analyzed. Outcome measures included the Massachusetts General Hospital Liking Scale, self-reported medication compliance, pill counts, and adverse events (AEs).
Euphoric effects and misuse/diversion of OROS-MPH were not significantly affected by substance use severity. The euphoric effects of OROS-MPH did not significantly differ between the adolescent and adult samples. Adults rated OROS-MPH as more effective in treating ADHD, whereas adolescents reported feeling more depressed when taking OROS-MPH. The adolescents lost more pills relative to the adults regardless of treatment condition, which suggests the importance of careful medication monitoring. Higher baseline use of alcohol and cannabis was associated with an increased risk of experiencing a treatment-related AE in OROS-MPH, but baseline use did not increase the risk of serious AEs or of any particular category of AE and the adolescents did not experience more treatment-related AEs relative to the adults.
With good monitoring, and in the context of substance abuse treatment, OROS-MPH can be safely used in adolescents with an SUD despite non-abstinence.
精神兴奋剂是治疗注意力缺陷多动障碍（ADHD）的有效药物，但可能会带来欣快感、滥用/转移用途以及不良反应。一些临床医生认为，与不滥用药物的成年人相比，药物滥用青少年面临的这些风险更大。本研究评估了与口服渗透泵控释哌甲酯（OROS-MPH）治疗患有物质使用障碍（SUD）的青少年ADHD相关的主观效应、滥用/转移用途及不良反应，并将这些风险与治疗无非尼古丁SUD的成人ADHD时的风险进行比较，这些风险是物质使用严重程度的函数。
分析了两项OROS-MPH治疗ADHD的随机安慰剂对照试验的数据集，一项试验有303名至少有一种非尼古丁SUD的青少年（13 - 18岁）参与，另一项有255名成年吸烟者（18 - 55岁）参与。结局指标包括麻省总医院喜好量表、自我报告的药物依从性、药丸计数及不良事件（AE）。
OROS-MPH的欣快感及滥用/转移用途未受物质使用严重程度的显著影响。OROS-MPH的欣快感在青少年和成人样本之间无显著差异。成人认为OROS-MPH治疗ADHD更有效，而青少年报告服用OROS-MPH时感觉更抑郁。无论治疗情况如何，青少年丢失的药丸比成人更多，这表明仔细监测用药的重要性。基线时较高的酒精和大麻使用量与服用OROS-MPH时发生治疗相关AE的风险增加有关，但基线使用情况并未增加严重AE或任何特定类型AE的风险，且青少年与成人相比并未经历更多治疗相关AE。
通过良好的监测，并且在药物滥用治疗的背景下，尽管未戒除药物，OROS-MPH仍可安全用于患有SUD的青少年。
