Evidence map›Paper›PMID 29617066›Full record

Trial reportThe Journal of clinical psychiatry

The Mixed Opioid Receptor Antagonist Naltrexone Mitigates Stimulant-Induced Euphoria: A Double-Blind, Placebo-Controlled Trial of Naltrexone.

Thomas J Spencer, Pradeep Bhide, Jinmin Zhu, Stephen V Faraone, Maura Fitzgerald, Amy M Yule, Mai Uchida, Andrea E Spencer, Anna M Hall, Ariana J Koster and 4 more

Registry-linked trialOpen access · greenAbstract readRandomized Controlled Trial
In one paragraph

Trial report in The Journal of clinical psychiatry. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT01673594 (Prevention of Stimulant-Induced Euphoria With an Opioid Receptor Antagonist), which is not on this map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.5field-weighted citation impact, top 35% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT01673594 phase4completednot on this map

Prevention of Stimulant-Induced Euphoria With an Opioid Receptor Antagonist

TypeinterventionalSponsorMassachusetts General HospitalRan2012 to 2015Enrolled37ConditionsADHD, Stimulant-Induced EuphoriaArmsSODAS MPH, Naltrexone
3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 9 citations in OpenAlex.

  1. Nicotine and the developing brain: Insights from preclinical models.Pharmacology, biochemistry, and behavior · 2022
    Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 4 institutions in 2 countries.

Thomas J SpencerMassachusetts General Hospital, 55 Fruit St, Warren 705, Boston, MA 02144. spencer@helix.mgh.harvard.edu.
Pradeep BhideDepartment of Neuroscience, Florida State University, Tallahassee, Florida, USA.
Jinmin ZhuDepartment of Neuroscience, Florida State University, Tallahassee, Florida, USA.
Stephen V FaraoneDepartment of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, Syracuse, New York, USA.
Maura FitzgeraldPediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA.
Amy M YulePediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA.
Mai UchidaPediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA.
Andrea E SpencerPediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA.
Anna M HallPediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA.
Ariana J KosterPediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA.
Leah FeinbergPediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA.
Sarah KassabianPediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA.
Barbara StorchPediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA.
Joseph BiedermanPediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston, Massachusetts, USA.
Massachusetts General Hospital · USFlorida State University · USHarvard University · USUniversity of Bergen · NO

Funding

AACAP Physician Scientist Program in Substance UseK12DA000357 · NIDA · AMERICAN ACADEMY-CHILD/ADOLESCENT PSYCH · PI Kevin M. Gray · 1998 to 2026
$29.1M
NIDA NIH HHS K12 DA000357
6 · The paper itself

Abstract

objectiveSupratherapeutic doses of methylphenidate activate μ-opioid receptors, which are linked to euphoria. This study assessed whether naltrexone, a mixed μ-opioid antagonist, may attenuate the euphoric effects of stimulants, thereby minimizing their abuse potential in subjects with attention-deficit/hyperactivity disorder (ADHD).

methodsWe conducted a 6-week, double-blind, placebo-controlled, randomized clinical trial of naltrexone in adults with DSM-IV ADHD receiving open treatment with a long-acting formulation of methylphenidate (January 2013 to June 2015). Spheroidal Oral Drug Absorption System methylphenidate (SODAS-MPH) was administered twice daily, was titrated to ~1 mg/kg/d over 3 weeks, and was continued for 3 additional weeks depending on response and adverse effects. Subjects were adults with ADHD preselected for having experienced euphoria with an oral test dose of 60 mg of immediate-release methylphenidate (IR-MPH). The primary outcome measure was Question 2 (Liking a Drug Effect) on the Drug Rating Questionnaire, Subject version, which was assessed after oral test doses of 60 mg of IR-MPH were administered after the third and sixth weeks of treatment with SODAS-MPH.

resultsThirty-seven subjects who experienced stimulant-induced (mild) euphoria at a baseline visit were started in the open trial of SODAS-MPH and randomized to naltrexone 50 mg/d or placebo. Thirty-one subjects completed through week 3, and 25 completed through week 6. Naltrexone significantly diminished the euphoric effect of IR-MPH during the heightened-risk titration phase (primary outcome; first 3 weeks) (χ² = 5.07, P = .02) but not the maintenance phase (weeks 4-6) (χ² = 0.22, P = .64) of SODAS-MPH treatment.

conclusionsPreclinical findings are extended to humans showing that naltrexone may mitigate stimulant-associated euphoria. Our findings provide support for further studies combining opioid receptor antagonists with stimulants to reduce abuse potential.

trial registrationClinicalTrials.gov identifier: NCT01673594.

Indexed as

AdolescentAdultAttention Deficit Disorder with HyperactivityCentral Nervous System StimulantsDouble-Blind MethodDrug Administration ScheduleDrug-Related Side Effects and Adverse ReactionsEuphoriaFemaleHumansMaleMethylphenidateNaltrexoneNarcotic AntagonistsTreatment OutcomeYoung AdultCentral Nervous System StimulantsMethylphenidateNaltrexoneNarcotic Antagonists

Identifiers

PMID29617066
PMCPMC6548180
OpenAlexW2793065610

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.