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RSAT Forum > Monthly Discussion > January 2021: Methamphetamine Use Disorder Treatment View modes: 
gbondquinn - 4/12/2021 10:43:44 AM
January 2021: Methamphetamine Use Disorder Treatment

Question: Are thre any medications to help people with methamphetamine disorders liek those for opioid use disorder? And what is the recommended treatment for methamphetamine use disorder?

Answer #1: There are no FDA-approved medications available for treatment of methamphetamine or other stimulant use disorders at this time. Behavioral interventions are currently recognized as best practice for treatment of stimulant use disorders. Nor are there any medications that can reverse a stimulant overdose. However, developing medications for the treatment of methamphetamine addiction is a national research priority. A long list of medications has been studied and several have shown promise. However, no pharmaceutical has been approved for treatment of any type of stimulant use disorder so far.

A new RSAT training tool is now available on the RSAT website, titled Treating Clients with Methamphetamine and Stimulant Use Disorders. It devotes an entire section to evidenced-based approaches to treating methamphetamine and other stimulant use disorders and how they apply to custody-based treatment. The manual also provides information on concurrent methamphetamine and opioid use, as well as methamphetamine use among individuals receiving medication-assisted treatment for opioid use disorder. It offers information on the complex relationship between methamphetamine use and mental health disorders and highlights the importance of RSAT program collaboration with mental health services. There is also information on the potential benefits psychiatric medication management may offer individuals recovering from chronic methamphetamine use. 

Answer #2: A new NIH study release in January found injectable naltrexone (Vivitrol®) and oral bupropion (an antidepressant used to aid nicotine cessation) is effective in treating adults with moderate to severe methamphetamine use disorder in a double blind, placebo controlled Phase III clinical trial, the final step in getting FDA approval. The findings suggest this combination therapy may be a promising addition to current approaches to treatment, such as cognitive behavioral therapy and contingency management interventions, for a very serious condition that remains difficult to treat and overcome. The research, published in The New England Journal of Medicine, was conducted at multiple sites within the National Institute on Drug Abuse Clinical Trials Network.  The study known as the Accelerated Development of Additive Pharmacotherapy Treatment for Methamphetamine Use Disorder study, or ADAPT-2, was conducted from 2017 to 2019 at clinics in multiple community treatment programs nationwide and enrolled 403 adult volunteers ages 18 to 65 years with moderate to severe methamphetamine use disorder.  In the study the treatment and comparison groups had four urine tests at the end of each stage of trial.  Those judged to have responded to treatment if they had at least three of four negative urine screens.  Overall, participants responded at a significantly higher rate in the treatment group. But the response rate was not terrific.   When screened during weeks five and six, 16.5% of those given the naltrexone/bupropion combination responded, compared to only 3.4% of those in the control group. Similarly, when screened in weeks 11 and 12, 11.4% of the treatment group responded, compared to 1.8% of the control group. However, this on a par with most medical treatments for mental health disorders, including antidepressants prescribed for depression. Importantly, there were no significant adverse effects associated with the dual medication treatment. Adherence to treatment was encouraged by adherence counseling and mobile app reminders and remained high at 77.4% and 82.0% in the treatment and placebo groups, respectively, in the final six weeks of the study. In previous clinical studies, however, both bupropion and naltrexone administered alone showed limited, inconsistent efficacy in treating methamphetamine use disorder. Now, in combination, these compounds seem to have an additive or synergistic effect.

The investigators of this experiment recommend future research testing if long naltrexone/pubropion treatment or concurrent behavioral therapy such as sontingency management would bring better results.