From the Guidelines
The recommended approach for managing methamphetamine withdrawal primarily involves supportive care, as there are no FDA-approved medications specifically for methamphetamine withdrawal. Treatment should focus on symptom management, including adequate hydration, nutrition, and rest in a calm environment. For severe agitation or psychosis, short-term use of benzodiazepines such as lorazepam (0.5-2mg every 4-6 hours as needed) or diazepam (5-10mg every 4-6 hours as needed) may be appropriate, as suggested by general clinical guidelines 1. Antipsychotics like olanzapine (5-10mg daily) or quetiapine (25-100mg at bedtime) can help manage psychotic symptoms. Sleep disturbances may be addressed with trazodone (50-100mg at bedtime) or mirtazapine (15-30mg at bedtime). Depression symptoms, which commonly emerge during withdrawal, may require antidepressants like sertraline (50-200mg daily) or bupropion (150-300mg daily).
Key Considerations
- Withdrawal management should be part of a comprehensive treatment plan that includes behavioral therapy, counseling, and support groups to address the underlying addiction.
- The combination of contingency management and community reinforcement approach has been found to be the most efficacious and most acceptable treatment for cocaine and/or amphetamine addiction in the short and long term 1.
- This approach recognizes that methamphetamine withdrawal is primarily psychological rather than physiologically dangerous, with symptoms including fatigue, increased appetite, depression, anxiety, and drug cravings that typically peak within 24-72 hours and may persist for 1-2 weeks or longer.
Psychosocial Interventions
- Cognitive behavioral therapy (CBT), contingency management (CM), and community reinforcement approach (CRA) are among the psychosocial interventions that have been studied for their efficacy in treating cocaine and amphetamine addiction 1.
- The choice of psychosocial intervention should be based on the individual's specific needs and circumstances, and may involve a combination of different approaches.
From the Research
Managing Methamphetamine Withdrawal
The recommended approach for managing methamphetamine withdrawal involves a combination of behavioral and pharmacological interventions.
- A novel treatment protocol comprising behavior-targeted and pharmacological components has been developed to reduce the intensity and duration of methamphetamine intoxication and withdrawal-related symptoms 2.
- This protocol includes pharmacological interventions such as ascorbic acid, antipsychotics, and other sedatives, as well as behavior-based orders.
- The effectiveness of contingency management intervention has been demonstrated in reducing methamphetamine use, with benefits including greater drug abstinence, higher utilization of other treatments and medical services, and reductions in risky sexual behavior 3.
Pharmacological Treatment
Several pharmacological treatments have been studied for methamphetamine withdrawal, including:
- Bupropion, which has been shown to be effective in increasing weeks of abstinence in methamphetamine-dependent patients, particularly those with low-to-moderate methamphetamine dependence 4.
- Amineptine, which may reduce discontinuation rates and improve global state compared to placebo, although this medication is no longer approved 5.
- Other medications, such as D-amphetamine and methylphenidate, have shown promise in early pilot data, but require further study to confirm their effectiveness 6.
Limitations and Future Directions
- The quality of evidence for pharmacological treatments for methamphetamine withdrawal is generally low to very low, indicating a need for better-powered, high-quality trials 5.
- Further research is needed to develop effective pharmacological treatments for methamphetamine withdrawal and to confirm the effectiveness of existing interventions.