Forty-two percent of individuals who had used MA in the prior 12 months also reported being diagnosed or treated for a concurrent mental illness—three times as high as the non-illicit drug-using population 80. Among MA users, the majority report a lifetime prevalence of depression and anxiety 81. The exclusion of relatively common comorbidities such as polydrug dependence and mental Amphetamine Addiction health comorbidities limits the generalisability of many of the studies. For example, the role of antipsychotic and antidepressant medications may differ in patients presenting with psychosis or depression. Similarly, dependence to other substances such as alcohol, benzodiazepines or opioids is also likely to impact upon the safety and efficacy and choice of medications. Medications such as topiramate and naltrexone may be worth further examination in patients with comorbid alcohol use, whereas the role of naltrexone will vary according to opioid status; for example, responding to stimulant use in patients enrolled in opioid agonist treatment.
Are Medications Used in Meth Treatment?
Of note, although CM and CBT both demonstrated positive outcomes individually, no clear synergism was observed when CM was combined together with CBT 96; however, when compared, the CM outperformed the CBT, e.g. 82. METH-induced depressive-anxious symptoms are usually treated with bupropion or a drive-increasing tricyclic antidepressant such as desipramine 1. Sleep disturbances and agitation during METH withdrawal are treated with sedating antidepressants or low-potency sedating antipsychotic drugs.
Cruickshank 2008 published and unpublished data
The combined mean duration of amphetamine use histories and length of time since last use of amphetamine prior to admission for the two studies on amineptine was 23.6 months and 55.2 hours, respectively. Participants in the Kongsakon 2005 study were detainees from a probation facility who were diagnosed with amphetamine dependence by DSM‐IV criteria. Participants in the Cruickshank 2008 study were those that met DSM‐IV criteria for amphetamine dependence, reported using amphetamine or methamphetamine within the last 72 hours, and were recruited from two drug and alcohol out‐patient clinics. Three evidence-based guidelines were identified that addressed the research questions.
Outcomes
- Amphetamine dependent individuals trying to discontinue or to cut down use of the drug using self‐help or even formal treatment commonly relapse, as a single use of amphetamine immediately removes discomfort and institutes a sense of well‐being or euphoria (Rawson 2002).
- 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.
- This seems to be true only if rewards are contingent upon the provision of drug-free urine samples, as non-contingent rewards were not shown to be effective (Fig 4).
- In clinical practice and in the studies reviewed, treatment is started as soon as possible following the last dose of amphetamine.
The studies that assessed CM efficacy in reducing METH abuse or dependence showed positive outcomes when comparing MUD patients to control group participants or CM to other behavioral therapies 74, 76. The benefits of CM intervention included reduced drug use, better treatment retention, reduction in psychiatric symptoms, higher utilization of other treatments and medical services, and reductions in risky sexual behavior. Importantly, CM worked not only in research treatment settings but also in community programs for MUD 79, 80.
Differential splicing analysis
- As aforementioned, the glutamatergic system plays a key role in MUD; consequently, several glutamatergic ligands have been evaluated for their efficacy to treat MUD as well.
- The most common primary outcome measure reported was abstinence (51 times, 55%), followed by cravings (10 times, 11%).
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- While these can be abused, they can be helpful for attention deficit and other disorders.
- There was no statistically significant main or interaction effect of either sertraline or CM for measures of MA use.
Two Iranian studies reviewed examined opioid agonists, one buprenorphine 57 and one buprenorphine and methadone 24. Both studies were in MA-dependent inpatient males with no co-occurring substance use disorder. The second study examined buprenorphine (8 mg SL OD) versus methadone (40 mg po OD) over 17 days, with 20 participants in each study arm. There was a reduction in MA craving compared with placebo, and no participants produced MA-positive UDS in the study period, but the setting was a controlled inpatient environment 24. We systematically reviewed the peer-reviewed literature via the electronic databases PubMed, EMBASE, CINAHL and SCOPUS for randomised controlled trials reported in the English language examining a pharmacological treatment for AMPH/MA dependence or use disorder.
Amphetamines are prescription medications or illegal substances that are also known as stimulants, as they speed up your metabolism and increase your alertness. When legally prescribed, they are typically used to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy. When people enter treatment, addiction has often caused serious consequences in their lives, possibly disrupting their health and how they function in their family lives, at work, and in the community. If you or someone you love are struggling with Adderall addiction or addiction to other amphetamines or stimulants, American Addiction Centers (AAC) is here to help. Nobody should be so naïve as to suppose that additional provisions regarding involuntary treatment can be a substitute for harm-reduction programs and other measures. Yes, people do have the right to take drugs or alcohol, but they don’t have the right to put the lives of others in danger.
Long-Term Effects of Meth Use
Although three studies reported data on withdrawal symptoms, only two studies involving 74 participants were included in the analysis (Srisurapanont 1999b; Cruickshank 2008). Data from Kongsakon 2005 for this specific outcome were not used because only median withdrawal scores were reported and means and standard deviations were needed for the comparison. However, the study did report significant improvements in amphetamine withdrawal symptoms as measured by the Amphetamine Withdrawal Questionnaire (AWQ) in the mirtazapine group versus placebo. Despite numerous clinical trials conducted to date, there is no consistently effective FDA-approved pharmacotherapy for MUD. Clinical trials testing potential medications for MUD have largely been negative, or did not show clear effectiveness or profile of safety. This is likely because heavy METH use is more damaging to the brain and body than light use of the drug and, therefore, light and heavy METH users respond differently to pharmacotherapies.
References to other published versions of this review
For now, psychotherapy is considered the first line of treatment for MUD even though it cannot serve as a standalone treatment of MUD due to poor compliance and high relapse rates once participants are out of a program. Apart from psychotherapy, other non-pharmacological interventions such as rTMS/tDCS or immunotherapies targeting MUD have been studied over recent years and show promise. Active immunotherapy provides specificity, safety, and long-lasting effects whereas passive immunotherapy allows high serum antibody concentration and is suitable for occasions when an immediate effect is required (e.g. METH overdose).
Current and Emerging Treatments for Methamphetamine Use Disorder
Participants randomised to topiramate returned significantly fewer MA-positive UDS at Week 6, but this result was not sustained throughout the final 4 weeks of the treatment period 55. Risk of bias in individual study methods and reporting are included in Supplementary Table 1 and Supplementary Data (see ESM) as considerations across a number of domains. Across all studies, allocation of participants was by random assignment, and all but three studies 46, 56, 66 were double-blind. Study completion rates were low, with studies reporting the proportion of the sample who did not complete the protocol as 38.4% of the total randomised. Eighty-three percent of studies analysed their results by intention-to-treat, while five (12%) 33, 46, 53, 57, 61 were unclear in this regard and two (5%) 24, 45 did not.