Randomised controlled trial of the short-term effects of osmotic-release oral system methylphenidate on symptoms and behavioural outcomes in young male prisoners with attention deficit hyperactivity disorder: CIAO-II study

Abstract

Background Research has shown that 20–30% of prisoners meet the diagnostic criteria for attention-deficit hyperactivity disorder (ADHD). Methylphenidate reduces ADHD symptoms, but effects in prisoners are uncertain because of comorbid mental health and substance use disorders. Aims To estimate the efficacy of an osmotic-release oral system methylphenidate (OROS-methylphenidate) in reducing ADHD symptoms in young adult prisoners with ADHD. Method We conducted an 8-week parallel-arm, double-blind, randomised placebo-controlled trial of OROS-methylphenidate versus placebo in male prisoners (aged 16–25 years) meeting the DSM-5 criteria for ADHD. Primary outcome was ADHD symptoms at 8 weeks, using the investigator-rated Connors Adult ADHD Rating Scale (CAARS-O). Thirteen secondary outcomes were measured, including emotional dysregulation, mind wandering, violent attitudes, mental health symptoms, and prison officer and educational staff ratings of behaviour and aggression. Results In the OROS-methylphenidate arm, mean CAARS-O score at 8 weeks was estimated to be reduced by 0.57 points relative to the placebo arm (95% CI −2.41 to 3.56), and non-significant. The responder rate, defined as a 20% reduction in CAARS-O score, was 48.3% for the OROS-methylphenidate arm and 47.9% for the placebo arm. No statistically significant trial arm differences were detected for any of the secondary outcomes. Mean final titrated dose was 53.8 mg in the OROS-methylphenidate arm. Conclusions ADHD symptoms did not respond to OROS-methylphenidate in young adult prisoners. The findings do not support routine treatment with OROS-methylphenidate in this population. Further research is needed to evaluate effects of higher average dosing and adherence to treatment, multi-modal treatments and preventative interventions in the community.

Psychiatric and legal considerations for ketamine treatment within prison settings

“…In contrast, medical treatment of ADHD in forensic settings is still controversially discussed ( 62 ), even though ADHD is estimated to affect at least 20% of PLP ( 63 ). While prior randomized controlled trials have provided encouraging results ( 64 ), a recent study has shown no short-term effects of methylphenidate in male PLP ( 65 ). Similarly, the use of OAT in prisons remains a contentious issue in many countries, although research suggests that it is associated with a reduction in overall mortality and drug-related poisonings following release ( 66 ).…”

Prevalence of attention‐deficit hyperactivity disorder in adult prisoners: An updated meta‐analysis

“…Therefore, service development should not be based on pooled estimates where inclusion criteria are too unspecific to be useful. With this in mind, the lack of efficacy found in a recent trial of stimulant medication for ADHD in prisoners (Asherson et al., 2023) may be due to the inclusion of mostly subthreshold cases (due to overdiagnosis) who did not respond to treatment and/or the high rates of comorbidity that could mask some of the effects of medication.…”

Protocol of a monocentric, double-blind, randomized, superiority, controlled trial evaluating the effect of in-prison OROS-methylphenidate vs. placebo treatment in detained people with attention-deficit hyperactivity disorder (BATIR)

“…These preliminary findings suffer from some important methodological shortcomings that limit their generalizability, including small sample sizes (n = 30 and n = 54), high attrition rates, a focus on participants with co-occurring amphetamine use disorder, and a lack of a control group to determine post-detention treatment effects [49]. The third study examined the effects of an 8-week OROS-MPH treatment in detained young men with ADHD (aged 18-25 years) in the UK [50,51]. ADHD symptoms did not respond to OROS-MPH.…”