From the Guidelines
Methamphetamine use disorder treatment should primarily rely on behavioral therapies, as there are no FDA-approved medications specifically for this condition, and current evidence supports the use of psychosocial interventions as first-line treatment. According to a systematic review and network meta-analysis published in 2018 1, psychosocial interventions such as contingency management, community reinforcement approach, and 12-step programme are recommended as first-line treatment for cocaine and/or amphetamine addiction.
Some key points to consider in the treatment of 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
- Cognitive behavioural therapy (CBT) alone or in combination with other interventions may also be beneficial in reducing methamphetamine use
- The importance of addressing co-occurring mental health conditions, such as psychosis, other mental illnesses, and cognitive deficits, which are common among individuals with stimulant use disorders 1
- The need for close supervision and monitoring of patients, particularly when using medications that may have potential side effects or interactions
While some medications, such as bupropion and naltrexone, are being investigated in clinical trials, the current evidence does not support their use as first-line treatment for methamphetamine use disorder. Therefore, treatment should focus on psychosocial interventions, with medications considered on a case-by-case basis, and always in conjunction with behavioral therapies.
From the Research
Medications for Methamphetamine Use Disorder
- There are currently no approved pharmacotherapies for methamphetamine use disorder, despite decades of research 2.
- Some medications, such as mirtazapine and methylphenidate, have shown promise in clinical trials, but results are often inconsistent and may depend on the specific subgroup of methamphetamine users being treated 2, 3.
- Methylphenidate has been found to reduce methamphetamine use in some studies, with low-strength evidence supporting its potential effectiveness 3.
Non-Pharmacological Interventions
- Contingency management (CM) has been shown to be an effective intervention for reducing methamphetamine use, with broad benefits including increased drug abstinence and reduced risky sexual behavior 4, 5.
- Cognitive behavioral therapy (CBT) and other behavioral interventions have also demonstrated treatment efficacy in promoting abstinence and reducing methamphetamine use or craving 5.
- Exercise, residential rehabilitation, and repetitive transcranial magnetic stimulation (rTMS) have also shown promise as non-pharmacological interventions for methamphetamine use disorder 5.
Future Directions
- Further research is needed to identify effective pharmacotherapies for methamphetamine use disorder, with a focus on molecular targets such as vesicular monoamine transporter 2 inhibitors and metabotropic glutamate receptor ligands 6.
- Preclinical studies should prioritize sex differences and pharmacogenetic approaches to determine if genetic variances are predictive of treatment outcomes 6.
- Clinical trials should include objective measures such as urinalysis and carefully monitor early treatment response and medication compliance to predict success or failure 2.