Pharmacological Treatment of Methamphetamine Amphetamine Dependence: A Systematic Review CNS Drugs

The benefits of mirtazapine have been less clear based on two randomised controlled trials, with one showing improvements in amphetamine withdrawal symptoms and the other showing no differences in withdrawal outcomes when compared to placebo. Seventy-nine percent of the reviewed studies excluded participants with comorbid mental health diagnoses or concomitant medications prescribed for comorbid mental health diagnoses. Research suggests that transient psychotic symptoms are observed in up to 40% of MA-using populations 79 and possibly more amongst treatment seekers.

Clinical trials

As a parent with an adult child with severe mental illness, the use of antipsychotics, voluntary or involuntary, is the only thing standing between my loved one and life on the streets. This document is prepared and intended for use in the context of the Canadian health care system. Articles were excluded if they did not meet the selection criteria outlined in Table 1, they were duplicate publications, or were published prior to 2009. The tolerance and withdrawal criteria are not considered to be met if the stimulant Amphetamine Addiction is used only under appropriate medical supervision. Comparison 1 Any pharmacological treatment versus Placebo, Outcome 2 Average score in global state.

• Find treatment programs in your state that treat recent onset of serious mental illnesses.
• Eight psychosocial interventions had at least 1 trial versus TAU, and all of them were directly compared with at least another psychosocial intervention.
• Although published separately, all three publications represented one unique guideline; therefore, one evidence-based guideline is reported.
• In addition to medication, it can be helpful to provide psychosocial and/or behavioral treatments for stimulant abuse to assist the patient in amphetamine withdrawal in sustaining abstinence from amphetamine once their treatment is completed (Lee 2008).
• This may cause collapsed veins, tetanus, abscesses, and damage to the heart, lungs, liver, and brain.
• Identifying addiction isn’t always easy and it’s best to leave diagnosis to healthcare professionals.

Are Medications Used in Meth Treatment?

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• Future research should address small sample sizes and low participant retention and treatment adherence rates, leading to underpowered studies lacking meaningful results.
• The nucleus accumbens receives glutamatergic input (green) from the prefrontal cortex, hippocampus and amygdala.
• From a clinical perspective, it is important to assess whether psychosocial interventions are effective and acceptable in both the short and long term, and also whether the combination of 2 approaches can produce a significant benefit.

Several major guidelines recommend the use of either CBT or CM alone for the treatment of cocaine and/or amphetamine addiction 6,8,10. We found that CBT alone was more acceptable than TAU (NNT 10.5, 95% CI 5.8–53.6), but it was not superior for abstinence on any dichotomous or continuous outcome measured and was less effective than CM alone. Both CBT and CM were inferior to CM in combination with community reinforcement approach at the longest follow-up after treatment completion. Community reinforcement approach alone was not different from TAU for abstinence at 12 weeks of treatment or at the end of treatment, but showed increased abstinence at the longest follow-up after treatment completion (NNT 4.1, 95% CI 2.4–36.2). CM plus community reinforcement approach was also superior to 12-step programme for abstinence and dropout at 12 weeks of treatment, for dropout at the end of treatment, and for abstinence at the longest follow-up after study completion. We found that CM alone or in combination with either community reinforcement approach or CBT had superior efficacy and acceptability compared to TAU at 12 weeks and at the end of treatment.

What are the principles of effective treatment?

The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of a substance use disorder. The test is free, confidential, and no personal information is needed to receive the result. Because addiction can affect so many aspects of a person’s life, treatment should address the needs of the whole person to be successful. Counselors may select from a menu of services that meet the specific medical, mental, social, occupational, family, and legal needs of their patients to help in their recovery. The mentally ill people on our streets today are often estranged from family and have no regular doctor. While the medical community recognizes the condition in the two former instances, it is often not recognized by the professional mental health community.

Amphetamines

• Naturalistic studies of amphetamine withdrawal symptoms and course are also crucial for the development of study designs appropriate for further treatment studies of amphetamine withdrawal.
• At Week 10 of the study there was a reduction in craving in the treatment arm, and the treatment arm demonstrated fewer positive UDS and reduced depressive symptoms at Week 10 compared with the placebo arm.
• Nine of the 43 studies (21%) enrolled only males 24, 29, 30, 34, 46, 52, 55, 57, 58, however not all of these were by design.
• The reviewers examined whether the decision to include the data obtained from studies in which most (50%‐75%) participants were amphetamine dependent or abuse affected the results of review.
• The figure plots the network of eligible direct comparisons for abstinence at the end of treatment (46 trials) (A) and dropout due to any cause (43 studies) (B).
• For this reason, we only reported data based on objective outcomes (abstinence on urinalysis and data on attrition), which are less likely to be influenced by the lack of blinding.

In 2015, illicit drugs cost tens of millions of disability-adjusted life years, with Europeans proportionately experiencing more, but with the greatest mortality rate in low- and middle-income countries 85. Indeed, recent cost-effectiveness analyses on psychosocial interventions for substance use are encouraging 8,86, but without a full economic model our recommendation cannot be made unequivocally. We reviewed pexacerfont in one study, a 3-week trial of 51 Iranian men within residential treatment camps where treatment is not normally provided 52.

The average score in global state was reported in three of the four included studies. Two studies (Srisurapanont 1999b; Jittiwutikan 1997) used the Clinical Global Impression or CGI (Guy 1976) and one (Cruickshank 2008) used the Brief Symptom Inventory Global Severity Index sub scale or BSI‐GSI (Derogatis 1993) to measure global state. In conducting a meta‐analysis, a fixed effect model, an analysis that ignores the between‐study variation, can give a narrower confidence interval than a random effect model.

• Monoamine transporter ligands have been tested for their inhibition of monoamine uptake.
• We assessed statistical heterogeneity in each pairwise comparison with τ2, I2 statistic, and P value 15.
• The high prevalence (about 87%) of amphetamine withdrawal in amphetamine users (Cantwell 1998, Schuckit 1999) suggests that clinical trials of potential medications for the treatment of amphetamine withdrawal are needed.

Chronic METH users are at higher risk for developing Parkinson’s disease than non-users 32. These findings implicate a compromised nigrostriatal pathway in individuals heavily dependent on METH. Animal studies showed that intermittent and long access stimulant self-administration changes the brain in different ways to influence motivated behavior 34.

For dropout at the end of treatment, the NNT ranged from 4.02 (95% CI 2.58–12.62) for CRA to 7.15 (95% CI 4.15–27.66) for non-contingent rewards, 10.52 (95% CI 5.83–53.65) for CBT, and 11.82 (95% CI 6.74–43.26) for CM. Extra-medical use of AMPH and MA is usually at higher doses than those prescribed orally, and through routes of administration that result in more rapid onset (inhaled, injected intravenously, intra-nasal, per-vaginal, and per-rectal). Extra-medical consumption of amphetamines may be for enjoyment and/or for performance enhancement (such as for night-shift workers to enable longer working hours) 5. Amphetamines refer to both amphetamine (AMPH) and the structurally similar methamphetamines (MA), both of which are used extra-medically. MA is considered a more potent derivative of AMPH, with a longer duration of action and increased ability to cross the blood–brain barrier; and global shifts in the illicit stimulant market have resulted in the predominance of MA 2, 3. Future research should consider the heterogeneity of amphetamine/methamphetamine dependence and the role of psychosocial intervention.

For abstinence, urine drug screens (UDS) were used 41 times (80%) and analysed or defined in 16 different ways. The most common method for analysing UDS was weekly proportion of AMPH/MA-free UDS, or overall proportion of AMPH/MA-free UDS. There were 75 distinct secondary outcomes inclusive of variations and often analysed differently to the primary outcomes of the same domain. The most common secondary outcome measure reported was craving (25 times), predominantly reported using the visual analogue scale (VAS) (16 times, 64% of the cravings measures).