Does Suboxone (buprenorphine/naloxone) help with methamphetamine cravings?

Suboxone for Methamphetamine Cravings

No, Suboxone (buprenorphine/naloxone) is not recommended as a standard treatment for methamphetamine cravings, as current guidelines explicitly state that no pharmacologic treatment for stimulant dependence, including methamphetamine, can be recommended for use in primary care settings. 1

Guideline-Based Recommendations

Current Standard of Care

• Behavioral therapies remain the only evidence-based treatment for methamphetamine dependence that can be recommended in clinical practice 1
• Despite continued research efforts exploring potential candidate medications, no pharmacologic treatment for stimulant dependence (including cocaine and methamphetamine) has achieved sufficient evidence for clinical recommendation 1

When to Refer

• Patients with methamphetamine use disorder should be referred to specialized addiction treatment programs that offer behavioral therapies such as cognitive-behavioral therapy, contingency management, and motivational enhancement therapy 1

Emerging Research Evidence (Not Yet Guideline-Supported)

While guidelines do not support buprenorphine for methamphetamine, recent research studies suggest potential benefit:

Craving Reduction Studies

• A 2021 randomized controlled trial found that buprenorphine added to the Matrix program significantly reduced methamphetamine craving scores (measured by CCQ-Brief) compared to placebo over 8 weeks, with effects persisting through 4-month follow-up 2
• A 2015 trial similarly demonstrated that buprenorphine augmentation significantly reduced craving and the ratio of positive urine tests for methamphetamine during Matrix program treatment 3
• Both studies also showed reductions in anxiety, depression, and stress scores among patients receiving buprenorphine 2

Mechanistic Rationale

• Preclinical research demonstrates that buprenorphine modulates methamphetamine-induced dopamine dynamics in the striatum, attenuating peak dopamine release evoked by methamphetamine 4
• This suggests buprenorphine may alter reward mechanisms through dopaminergic system modulation 2, 4

Comparative Effectiveness Data

• A 2022 secondary analysis of patients with opioid use disorder found no significant difference in methamphetamine use between buprenorphine/naloxone and extended-release naltrexone treatment arms, though buprenorphine subjects had approximately half the odds of methamphetamine use (OR=0.50; p=0.051) 5
• Importantly, this study found that methamphetamine use frequency did not decline over time in either treatment group, and odds of use slightly increased with each later visit 5

Critical Clinical Considerations

Important Caveats

• The research evidence is limited to small trials (40-105 participants) conducted primarily in single centers 2, 3
• These studies examined buprenorphine as an adjunct to behavioral therapy (Matrix program), not as monotherapy 2, 3
• No mortality or quality-of-life outcomes have been reported in these trials—only surrogate markers like craving scores and urine drug tests 2, 3

If Considering Off-Label Use

If a clinician considers off-label buprenorphine for methamphetamine use disorder despite lack of guideline support:

• Ensure the patient does not have opioid use disorder, as buprenorphine is FDA-approved only for opioid dependence 6
• Combine with intensive behavioral therapy—never use as monotherapy 2, 3
• Monitor for misuse potential, as buprenorphine itself has abuse liability despite the naloxone component 6
• Obtain specialty consultation from addiction medicine, as this represents off-label use without guideline support 1

Common Pitfall to Avoid

• Do not prescribe buprenorphine for methamphetamine cravings in routine primary care practice—this contradicts current evidence-based guidelines and could expose patients to unnecessary risks from an opioid medication without proven benefit for their condition 1
• Patients with methamphetamine use disorder who discontinue behavioral treatment are at risk for relapse, but adding an opioid medication is not the solution 1

Practical Algorithm

For patients presenting with methamphetamine use disorder:

1. Screen for co-occurring opioid use disorder using DSM-5 criteria 1

   • If opioid use disorder is present: Initiate buprenorphine for the opioid disorder per standard protocols 1
   • If only methamphetamine use disorder: Proceed to step 2

2. Refer to behavioral therapy as first-line treatment 1

   • Matrix program, cognitive-behavioral therapy, or contingency management 1

3. Consider specialty referral to addiction medicine if behavioral therapy fails or patient has complex comorbidities 1

4. Do not initiate buprenorphine for methamphetamine cravings alone in primary care settings, as this lacks guideline support and FDA approval for this indication 1