Inequality in Smoking Cessation Trials for Adults with ADHD and MHD

Adults with Attention Deficit Hyperactivity Disorder (ADHD) are more likely to smoke and find it difficult to quit smoking.

ADHD is a neurological developmental disorder that affects children and adults, characterized mainly by symptoms of inattention and hyperactivity. The US Food and Drug Administration (FDA) explains that nicotine can alter brain function, leading to nicotine addiction and smoking dependency.

Medical News Today explains that the stimulating effects of nicotine may help improve the attention of individuals with ADHD, suggesting that nicotine may aid in controlling their symptoms.

Meanwhile, a recently published study in the British Medical Journal (BMJ) emphasizes that smokers with mental illnesses are underrepresented in clinical trials for smoking cessation. Data consistently shows that individuals with mental illnesses are more likely to smoke than non-smokers, making it crucial to include them in clinical trials related to quitting smoking. Unfortunately, the opposite seems to be true.

People with mental health disorders who smoke are excluded from smoking cessation clinical trials. The headline is "Inequality in Smoking Cessation Clinical Trials Testing Drug Therapies: Excluding Smokers with Mental Health Disorders." This commentary aims to examine the practice and reasons behind excluding smokers with mental health disorders (MHD) from such clinical trials.

A research team has analyzed the Cochrane systematic review database up to September 2020 to obtain an evaluation of drug therapy for smoking cessation. "We included 279 randomized controlled trials from 13 Cochrane reviews. In all studies, 51 (18.3%) explicitly excluded participants with any mental health disorders, 152 (54.5%) conditionally excluded them based on certain mental health disorder criteria, and 76 (27.2%) provided insufficient information to determine inclusion or exclusion. The study found that, compared to nicotine replacement therapy studies, studies on antidepressant drugs used for smoking cessation were 3.33 times more likely to conditionally exclude smokers with mental health disorders (95% CI 1.38 to 8.01, p=0.007)," the researchers reported.

In fact, their conclusion was that there were not enough participants with MHD (mental health disorders) in clinical trials testing the safety and efficacy of smoking cessation drugs, and there was not enough data collected to explain why. The study highlights the importance of promoting participation from this minority group in trials.