Efficacy and safety of psychostimulants for amphetamine and methamphetamine use disorders: a systematic review and meta-analysis

Abstract

BackgroundAmphetamine and methamphetamine use disorders are associated with severe health and social consequences. No pharmacological therapy has been approved for the treatment of these disorders. Psychostimulants can act as maintenance-like therapies for managing substance use among these patients.The aim of this study is to evaluate the literature examining the efficacy and safety of psychostimulant agents for increasing abstinence and treatment retention among patients with amphetamine and methamphetamine use disorders.MethodsWe searched MEDLINE, EMBASE, PsycInfo, Cochrane Central, and CINAHL from inception to August 2016. Selection of studies, data extraction, and risk of bias assessment were conducted independently by two reviewers. We conducted meta-analyses to provide a pooled summary estimate for included trials and report the review according to PRISMA guidelines.ResultsWe identified and selected 17 studies with 1387 participants. Outcome reporting across trials was inconsistent, and the overall quality of evidence was very low due to high risk of bias and indirectness. A meta-analysis of five trials (642 participants) found no effect of psychostimulants for end-of-study abstinence (odds ratio = 0.97, 95% confidence interval 0.65 to 1.45). Additionally, the pooled estimate from 14 studies (1184 participants) showed no effect of psychostimulants for treatment retention (odds ratio = 1.20, 95% confidence interval = 0.91 to 1.58). The incidence of serious adverse events did not differ between intervention and placebo groups based on qualitative reports from trials.ConclusionsQuantitative analyses showed no effect of psychostimulants for sustained abstinence or treatment retention. We also identified the need for more rigorous studies in this research area with clinician and patient important outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0370-x) contains supplementary material, which is available to authorized users.

Treatment of stimulant use disorder: A systematic review of reviews

“…However only five studies were included in this subgroup analysis. Authors found no effect on treatment retention, but a small subgroup analysis suggested improvement with longer duration of psychostimulant treatment [37].…”

“…It is hypothesized that psychostimulant treatment for stimulant use disorder may be effective by substituting a slow acting drug with a similar mechanism of action, thereby reducing withdrawal symptoms and cravings [36]. Eight reviews and metaanalyses assessing the use of psychostimulants for treatment of stimulant use disorder have been included in this review: four were appraised as core [25,27,36,49], and four have been included as supplementary evidence [37][38][39][40]. Reviews focused on a single medication have been included as sub-categories.…”

Perfil de drogas de abuso apreendidas e admitidas no Instituto de Polícia Científica entre os meses de janeiro a novembro de 2017

“…Ainda entre as drogas estimulantes do SNC temos as anfetaminas, essas substâncias são drogas sintéticas que apresentam níveis crescentes de abuso principalmente entre jovens, gerando um problema de saúde pública, uma vez que a partir da primeira exposição pode-se avançar de forma rápida a dependência. Entre elas temos a 3,4metilenodioximetanfetamina, conhecida por MDMA, droga com ação estimulante e alucinógena, denominada popularmente por ecstasy [11][12].…”

Update on methamphetamine: an old problem that we have recently encountered

“…A recent systematic review found no effect of psychostimulant agents on sustained abstinence or retention in treatment (58). Novel approaches for the treatment of methamphetamineuse disorder include neuroimmune modulators (minocycline, ibudilast), cognitive enhancers (rivastigmine, galantamine, atomoxetine, modafinil, citicoline), vaccines, and oxytocin (59).…”