Study Design for a Randomized Study Design for a Randomized Controlled Trial of Controlled Trial of Osmotic-Release Methylphenidate Osmotic-Release Methylphenidate (OROS-MPH) (OROS-MPH) for Attention Deficit for Attention Deficit Hyperactivity Disorder Hyperactivity Disorder in Adolescents with Substance in Adolescents with Substance Use Disorders Use Disorders June 14, 2006, Pharmacological Treatment of ADHD in Substance-Abusing Adolescents and Adults: New Findings, Research Directions, and Clinical Implications: 3:10 – 3:30 Presenter: Theresa Winhusen, Ph.D.
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Study Design for a Randomized Controlled Trial of Osmotic-Release Methylphenidate (OROS-MPH) Osmotic-Release Methylphenidate (OROS-MPH) for Attention Deficit.
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Study Design for a Randomized Controlled Trial ofStudy Design for a Randomized Controlled Trial of Osmotic-Release Methylphenidate (OROS-MPH)Osmotic-Release Methylphenidate (OROS-MPH) for Attention Deficit Hyperactivity Disorderfor Attention Deficit Hyperactivity Disorder in Adolescents with Substance Use Disordersin Adolescents with Substance Use Disorders
June 14, 2006, Pharmacological Treatment of ADHD in Substance-Abusing Adolescents and Adults: New Findings, Research Directions, and Clinical Implications: 3:10 – 3:30
Presenter: Theresa Winhusen, Ph.D.
Principal InvestigatorsPrincipal Investigators
Principal Investigator– Paula Riggs MD University of Colorado at Denver
& Health Sciences Center (UCDHSC)
Co-Principal Investigators– Theresa Winhusen PhD– Robert Davies MD, Medical Co LI (UCDHSC)
Principal Investigator– Paula Riggs MD University of Colorado at Denver
& Health Sciences Center (UCDHSC)
Co-Principal Investigators– Theresa Winhusen PhD– Robert Davies MD, Medical Co LI (UCDHSC)
30-50% of adolescents in substance treatment have ADHD
ADHD associated with: More severe substance abuse Worse behavior problems Poorer treatment outcomes
30-50% of adolescents in substance treatment have ADHD
ADHD associated with: More severe substance abuse Worse behavior problems Poorer treatment outcomes
Integrated treatment is considered to be a core drug Integrated treatment is considered to be a core drug treatment principle (NIDA, 1999)treatment principle (NIDA, 1999)
Recent community treatment surveyRecent community treatment survey < 50% had “dual diagnosis” programs< 50% had “dual diagnosis” programs Of those with dual diagnosis programs:Of those with dual diagnosis programs:
43.4% did not offer prescription meds43.4% did not offer prescription meds
37.8% did not offer psychiatric/psychological evaluation37.8% did not offer psychiatric/psychological evaluationMotjabai, Motjabai,
20042004
Integrated treatment is considered to be a core drug Integrated treatment is considered to be a core drug treatment principle (NIDA, 1999)treatment principle (NIDA, 1999)
Recent community treatment surveyRecent community treatment survey < 50% had “dual diagnosis” programs< 50% had “dual diagnosis” programs Of those with dual diagnosis programs:Of those with dual diagnosis programs:
43.4% did not offer prescription meds43.4% did not offer prescription meds
37.8% did not offer psychiatric/psychological evaluation37.8% did not offer psychiatric/psychological evaluationMotjabai, Motjabai,
Schedule II psychostimulants, gold standardSchedule II psychostimulants, gold standard Non-scheduled alternatives-- bupropion and Non-scheduled alternatives-- bupropion and
atomoxetine-- have lower effect sizes (.5 and .7)atomoxetine-- have lower effect sizes (.5 and .7)
OROS-MPH/Concerta OROS-MPH/Concerta Long acting (12 hours); once daily dosingLong acting (12 hours); once daily dosing Equivalent efficacy to short acting psychostimulantsEquivalent efficacy to short acting psychostimulants Controlled delivery system likely reduces abuse Controlled delivery system likely reduces abuse
potentialpotential
Schedule II psychostimulants, gold standardSchedule II psychostimulants, gold standard Non-scheduled alternatives-- bupropion and Non-scheduled alternatives-- bupropion and
atomoxetine-- have lower effect sizes (.5 and .7)atomoxetine-- have lower effect sizes (.5 and .7)
OROS-MPH/Concerta OROS-MPH/Concerta Long acting (12 hours); once daily dosingLong acting (12 hours); once daily dosing Equivalent efficacy to short acting psychostimulantsEquivalent efficacy to short acting psychostimulants Controlled delivery system likely reduces abuse Controlled delivery system likely reduces abuse
potentialpotential
Standardized SUD TreatmentStandardized SUD Treatment
OROS-MPH (72mg/day) vs placeboOROS-MPH (72mg/day) vs placebo CBT for SUDCBT for SUD
WeeklyWeekly OutpatientOutpatientPowerPower
N= 300 to detect low/medium effect size (.4)N= 300 to detect low/medium effect size (.4) 11 study sites11 study sites
Study SitesStudy Sites
Wave 1 Wave 1 • LRADAC, South CarolinaLRADAC, South Carolina• Synergy, ColoradoSynergy, Colorado• STARR, Northern New EnglandSTARR, Northern New England
Wave 2 Wave 2 • Operation PAR, FloridaOperation PAR, Florida• Gateway, FloridaGateway, Florida• Mountain Manor, Mid-AtlanticMountain Manor, Mid-Atlantic• Crittenton, Ohio Valley Crittenton, Ohio Valley • St Lukes Roosevelt, Long Island St Lukes Roosevelt, Long Island • MHMR of Tarrant County, TexasMHMR of Tarrant County, Texas• Rehab After Work, Delaware ValleyRehab After Work, Delaware Valley• Addiction Medicine Services, Appalachian Tri StateAddiction Medicine Services, Appalachian Tri State
Study ParticipantsStudy Participants
ParticipantsInclusion
Adolescents (13-18) DSM IV ADHD At least one SUD
Exclusion serious medical illness bipolar psychosis opiate dependence methamphetamine abuse, dependence other treatment; psychotropics