From the Guidelines
The best care practices for patients undergoing methamphetamine withdrawal involve a supportive environment with symptomatic treatment for relief of symptoms such as agitation, sleep disturbance, and monitoring for depression or psychosis. According to the most recent and highest quality study available 1, withdrawal from amphetamines, including methamphetamine, is best undertaken in a supportive environment without specific medication for the treatment of withdrawal. However, relief of symptoms may be achieved with symptomatic medication for the period of the withdrawal syndrome.
Key Components of Care
- Placement in a calm, monitored setting for regular vital sign checks due to potential cardiovascular stress
- Symptomatic treatment for:
- Agitation and psychosis: benzodiazepines like lorazepam or antipsychotics such as olanzapine may be used short-term
- Sleep disturbances: trazodone rather than benzodiazepines for prolonged use
- Hydration and nutrition support to address dehydration and electrolyte imbalances
- Close monitoring for depression due to suicide risk, with antidepressants typically not started until after the acute withdrawal phase
Transition to Comprehensive Addiction Treatment
Following acute management, patients should transition to comprehensive addiction treatment including behavioral therapies such as cognitive-behavioral therapy or contingency management, as suggested by 1. This approach is crucial for addressing both the immediate physiological withdrawal symptoms and the underlying psychological aspects of methamphetamine dependence.
Ongoing Support and Monitoring
The withdrawal process typically peaks within 24-72 hours, but psychological symptoms like cravings, depression, and anhedonia may persist for weeks to months. Ongoing support and monitoring are essential for managing these symptoms and preventing relapse, as indicated by the principles outlined in 1 for opioid withdrawal, which can be applied to the management of withdrawal from other substances like methamphetamine in terms of the importance of supportive care and monitoring.
From the Research
Best Care Practices for Methamphetamine Withdrawal
- The treatment of methamphetamine withdrawal often involves a combination of pharmacological and behavioral interventions 2, 3, 4, 5.
- Medications such as modafinil, bupropion, and buprenorphine have been studied for their potential in reducing methamphetamine withdrawal symptoms and cravings 2, 3.
- Buprenorphine has been found to be effective in reducing methamphetamine cravings, with one study showing that it was superior to bupropion in this regard 3.
- Behavioral interventions, such as cognitive-behavioral therapy (CBT) and contingency management (CM), have also been shown to be effective in reducing methamphetamine use and improving treatment outcomes 5.
- A novel treatment protocol that combines behavioral and pharmacological components has been developed and shown to be feasible, tolerable, and effective in reducing the intensity and duration of methamphetamine withdrawal symptoms 4.
Pharmacological Interventions
- Modafinil has been studied as a potential treatment for methamphetamine withdrawal, but its efficacy is still unclear due to the small sample size of the study 2.
- Bupropion and buprenorphine have been found to be effective in reducing methamphetamine cravings, with buprenorphine being superior to bupropion 3.
- Ascorbic acid, antipsychotics, and other sedatives may also be used as pharmacological interventions in the treatment of methamphetamine withdrawal 4.
Behavioral Interventions
- CBT has been shown to be effective in reducing methamphetamine use and improving treatment outcomes, even over short periods of treatment 5.
- CM has also been found to be effective in reducing methamphetamine use, but its long-term effects are still unclear 5.
- Behavioral interventions should be tailored to the individual patient's needs and may involve a combination of different approaches 5.
Withdrawal Symptoms and Phases
- Methamphetamine withdrawal symptoms can be categorized into two phases: the acute phase, which lasts 7-10 days, and the subacute phase, which lasts at least 2 weeks 6.
- The acute phase is characterized by increased sleeping and eating, depression-related symptoms, and anxiety and craving-related symptoms 6.
- The subacute phase is characterized by stable and low levels of withdrawal symptoms 6.