From the Guidelines
Psychosocial interventions, such as contingency management, community reinforcement approach, and 12-step programme, are the primary treatments for methamphetamine use disorder, with no FDA-approved medications specifically for this condition. According to a systematic review and network meta-analysis published in 2018 in PLoS Medicine 1, international clinical guidelines recommend the use of psychosocial interventions as first-line treatment, with little evidence supporting pharmacotherapy or brain stimulation treatments.
Some key points to consider when treating methamphetamine use disorder include:
- The use of contingency management, which provides rewards for drug-free urine samples, has been shown to be moderately efficacious at the end of treatment 1
- Community reinforcement approach, a multi-layered intervention involving functional analysis, coping-skills training, and social, familial, recreational, and vocational reinforcements, is also a recommended treatment approach 1
- 12-step programme, a set of guiding principles outlining a course of action for self-help recovery from addiction, is another option for treatment 1
While medications such as bupropoin, naltrexone, and mirtazapine may be used off-label to manage symptoms associated with methamphetamine withdrawal, they should only be used as part of a comprehensive treatment approach that includes behavioral therapy, counseling, and support groups. It is essential to individualize treatment based on patient characteristics, comorbidities, and treatment goals, and to regularly monitor for side effects and treatment response 1.
From the Research
Medications for Methamphetamine Use Disorder
Several medications have been tested for the treatment of methamphetamine use disorder, including:
- Mirtazapine and methylphenidate, which have shown promise in clinical trials, particularly in subgroups of patients 2
- Modafinil, antipsychotic medications, and baclofen, which have been tested in animals but have not produced long-term changes in methamphetamine use in dependent individuals 3
- Atomoxetine and varenicline, which may be useful in ameliorating the psychotomimetic effects of methamphetamine or reversing methamphetamine-induced cognitive deficits 3
- Vesicular monoamine transporter 2 inhibitors, metabotropic glutamate receptor ligands, and trace amine-associated receptor agonists, which have shown efficacy in attenuating the reinforcing effects of methamphetamine in preclinical studies 3
- Bupropion and naltrexone, which have been studied in a clinical trial and shown to have a higher response rate than placebo in adults with moderate or severe methamphetamine use disorder 4
Clinical Trials and Treatment Outcomes
Clinical trials have been conducted to evaluate the efficacy and safety of these medications, including:
- A multisite, double-blind, two-stage, placebo-controlled trial of extended-release injectable naltrexone plus oral extended-release bupropion in adults with moderate or severe methamphetamine use disorder 4
- Randomized placebo-controlled trials of other medications, such as mirtazapine and methylphenidate, which have shown promise in subgroups of patients 2
Limitations and Future Directions
Despite the promise of these medications, there are limitations to their use, including:
- The lack of FDA-approved medications for methamphetamine use disorder 5, 6
- The heterogeneity of the population and the lack of studies in patients with various comorbidities 6
- The need for further research on the molecular targets of methamphetamine use disorder and the development of new pharmacotherapies 3