New research offers scarce hope for treatment of methamphetamine use disorders

A study funded by the US government provided evidence of a promising treatment for people struggling with methamphetamine use. People receiving combination drug therapy were more likely to avoid the drug and report improvements in their lives than those receiving standard support and a placebo, according to the study. The results are all the more encouraging given that methamphetamine use disorder is particularly difficult to treat.

In recent years, the drug overdose crisis has only worsened. There have been over 70,000 overdose deaths in 2019, and 2020 is strongly expected to be worse, in part thanks to the covid-19 pandemic. Much of the crisis has been focused on opioids, but it has become evident that the abuse of other drugs, including stimulants like methamphetamine, is on the rise as well.

While it is difficult for many people with drug addiction to find help, there are treatments available for opioid use and alcohol use disorders, as well as for quitting smoking. . These include drugs that reduce craving and withdrawal symptoms that can be associated with counseling and therapy. To date, however, there is no drug known to reduce these symptoms specifically for methamphetamine use.

This new study, published On Wednesday in the New England Journal of Medicine, tested a combination of two drugs: bupropion, an antidepressant and smoking cessation aid, as well as naltrexone, used to treat opioid and alcohol use disorders .

The trial involved 403 volunteers with moderate to severe methamphetamine use disorder who were randomized to the treatment group or the placebo group. A second cycle of the trial, involving people in the placebo group who did not respond to treatment, was carried out with 225 volunteers. Those in the treatment group received an injection of naltrexone every three weeks and a daily pill of bupropion, then they were monitored for six weeks. Participants from both groups met with clinicians weekly and received counseling; they also had their urine tested for methamphetamine.

In both trials, the percentage of people who responded to treatment (defined as methamphetamine negative at least three out of four times) was low for both groups. But it was significantly higher for people on medication. On average, 13.6% of people taking bupropion and naltrexone responded to treatment, compared to 2.5% of people taking placebo. In surveys conducted by the volunteers, those in the experimental group seemed to report less cravings and greater improvement in quality of life over the duration of the trial, although the researchers caution that these results are less certain. There were no serious treatment-related side effects, but users showed a higher risk of nausea, vomiting, and constipation compared to the placebo group.

The benefits of this combination therapy are probably modest at best. But the authors note that the level of improvement seen in this study is roughly similar to other established treatments for certain mental health and substance abuse disorders, including unhealthy alcohol dependence. If nothing else, this could represent the first evidence-based drug for methamphetamine use disorder, a serious illness that can lead to health complications such as heart and brain damage, as well as hallucinations, paranoia, and severe tooth decay and loss.

“This breakthrough demonstrates that medical treatment for methamphetamine use disorders can help improve patient outcomes,” said Nora Volkow, director of the National Institute on Drug Abuse, which helped conduct the study, in one declaration published by the federal agency.

Although the study paves the way for wide use of this combination therapy for these patients, future studies will need to test its effectiveness in more real-life settings and over longer time periods, the authors wrote.