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Heroin Addiction and Related Clinical Problems: 2009, 11, 1 (pages: 5 - 14)

Treatment of Opioid Dependence and ADHD/ADD with Opioid Maintenance and Central Stimulants

Blix O., Dalteg A., Nilsson P.

Summary: Since January 2005 Medically Assisted Rehabilitation of opiate addicts (MAR) is a regular treatment supported by the National Board of Health and Welfare in Sweden. Treatment facilities are now open in most parts of Sweden. At the addiction medicine unit in Jönköping, high dose buprenorphine has been used since 1999, and methadone was added in 2005, when the previously separate regulations for the use of those two substances were merged in the present regulations. ADHD and ADD, together with OCD, are relatively common disorders among drug addicts. Since 2004 we have diagnosed over 150 patients with these disorders at the addiction medicine unit. By November 2007, treatment with long-acting methylphenidate or modafinil had been initiated in 85 subjects. Of those 85, 12 had also met the criteria for opioid substitution. This paper will discuss our experiences with the combined treatment with opioids and central stimulants, as administered to those drug addicts. In this naturalistic study, all 12 subjects (1 female), mean age 38 (range 20 to 51) were evaluated before starting Central Stimulant (CS) treatment with clinical interviews, self-assessments and formal computerized tests (EuroCog). The ambition is to follow each patient's development through the use of drug tests, interviews (subjects and relatives/significant others), and a retest to evaluate the outcome of the combined treatment.