The New England Journal of Medicine (January 2021) has published the results of a successful clinical trial, using two approved medications for the treatment of methamphetamine use disorder. There is currently no approved medication to treat addiction to methamphetamines. Behavioral interventions are the best available treatment at this time.
Pharmacotherapy Treatment for Methamphetamine Use Disorder (or ADAPT-2) study, conducted by NIDA’s Clinical Trials Network and led by Madhukar H. Trivedi, M.D., of the University of Texas Southwestern Medical Center, Dallas, found that a combination of oral bupropion, a commonly prescribed medication used to treat depression and for nicotine cessation, and injectable naltrexone, an opioid antagonist widely prescribed for treating opioid and alcohol use disorders, successfully reduced methamphetamine use and cravings in a large sample of treatment-seeking people with methamphetamine use disorder, compared to placebo.
Dr. Nora Volkow, Director NIDA
Why is Methamphetamine Use Disorder Medication Important?
A recent CDC Health Advisory warned that in 2020 there were significant increases in overdose deaths involving stimulant drugs such as methamphetamine and cocaine. And according to the CDC, this is likely because people are using these drugs in combination with opioids (like heroin or fentanyl). Similarly, they may have unknowingly used products that are laced with fentanyl.
Methamphetamine Use and Effects
Reports from the International Journal of Drug Policy state that increasing numbers of individuals are injecting methamphetamine and opioids together.
Those who combine heroin and cocaine or methamphetamine report that using a stimulant together with opioids, “balances” the effects and allows them to function “normally.” But, the combination of stimulants and opioids can increase each individual drug’s toxicity and deadliness.
Also, people are using methamphetamines instead of opioids because they fear opioids may be laced with fentanyl. However, fentanyl is also found in methamphetamines.
Overdoses are not the only hazard to using methamphetamines. Cognitive and health problems arise with consistent use. And those injecting cocaine or methamphetamines with shared equipment can transmit infectious diseases. Likewise, methamphetamine use may worsen HIV progression and increase cognitive problems.
Given methamphetamine addiction’s devastating health effects and the extreme stigma that surrounds it, developing medications or immunotherapies would provide additional therapeutic alternatives, which could also be used to augment the benefits from behavioral interventions.
Dr. Nora Volkow, Director NIDA
More research is needed on how to best implement the combination of bupropion and naltrexone in the treatment of methamphetamine use disorder. It has not yet been submitted for regulatory review. But the ADAPT-2 trial provides hope that a medical advancement can help to assuage the devastation caused by the overdose crisis.
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