Methamphetamine Toxicities and Clinical Management

Coffin, Phillip O.; Suen, Leslie W.

doi:10.1056/evidra2300160

Cited by 7 publications

(4 citation statements)

References 74 publications

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“…40 Additional interventions should be considered to support PrEP adherence among people at risk for HIV who use methamphetamine. Contingency management has been shown to be the most effective intervention for reducing methamphetamine use among people with methamphetamine use disorder 41,42 and has been shown to improve adherence to antiretroviral treatment among people with HIV. 43,44 Moreover, contingency management has been associated with increased post-exposure prophylaxis course completion and adherence among MSM who use stimulants.…”

Section: Discussionmentioning

confidence: 99%

“…While there are no FDA-approved medications for stimulant use disorder, there are several potential agents under study and used off-label. 42 Assessing people who are receiving medications for methamphetamine use disorder for PrEP indications is warranted, and co-prescribing PrEP could synergistically reduce methamphetamine use and HIV risk. In addition to combining PrEP with interventions for methamphetamine use disorder, providing PrEP at syringe services programs (SSPs) is a promising approach to increase PrEP engagement among people who use methamphetamine.…”

Section: Discussionmentioning

confidence: 99%

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Challenges recruiting and retaining people at risk for HIV who use methamphetamine in a randomized PrEP adherence trial in Seattle, WA

McMahan,

Atkins,

Buckler

et al. 2024

Int J STD AIDS

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Background Methamphetamine is associated with increased HIV risk and suboptimal adherence to pre-exposure prophylaxis (PrEP). Interventions to support PrEP adherence for people who use methamphetamine are needed. Methods We evaluated peer navigation to support adherence among people initiating PrEP who use methamphetamine. The HIV Prevention in Methamphetamine Users (HMU!) study enrolled participants from May 2018-January 2022 in Seattle, WA, and followed them for 6 months. Surveys collected sociodemographic, drug use, and sexual behavior data at enrollment, month 3, and month 6. Dried blood spots (DBS) were collected at months 1, 3, and 6 to measure PrEP adherence. Results We enrolled 21 participants of a target sample of 40, of whom 20 were prescribed PrEP. Nine participants (43%) received peer navigation and 12 (57%) received standard of care or text messaging. At baseline, most participants reported at least weekly methamphetamine use (17, 81%) and condomless receptive anal intercourse (CRAI) (16, 76%). One-third reported CRAI with a partner with HIV. Among those who provided a DBS, 78% and 50% had results commensurate with ≥4 pills/week at the month 3 and 6 visit, respectively. More than half of those prescribed PrEP completed a month 6 visit (11, 55%). Retention was not associated with peer support compared to standard of care or text messaging ( p = .20). Conclusions We enrolled half our target sample size despite extensive recruitment efforts. As expected, participants had challenges with PrEP adherence and persistence. While peer navigation interventions should be studied further, additional interventions are likely needed to support PrEP uptake, adherence, and persistence among people who use methamphetamine.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Challenges recruiting and retaining people at risk for HIV who use methamphetamine in a randomized PrEP adherence trial in Seattle, WA

McMahan,

Atkins,

Buckler

et al. 2024

Int J STD AIDS

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“…Substance use history should include route of administration, frequency/duration of use, and co-administration with other drugs, but considering the significant stigma that comes with substance use, this can be a challenging history to obtain. Coffin et al recommend a motivational interviewing style to assess the patient’s understanding of the benefits and harms of meth in addition to their goals regarding future use ( 98 ). Zhu et al ( 39 ) found that, after excluding those with recent exposure to medications that can lead to false positives, 7.7% (29/379) of patients in a hemorrhagic stroke cohort who denied meth use tested positive for amphetamines on a urine drug screening.…”

Section: Diagnostic Challenges and Managementmentioning

confidence: 99%

“…Mirtazapine has shown some promise in phase 2 trials for the reduction of meth use and of sexual risk behaviors that can increase risk of HIV infection, but additional research on larger populations is needed ( 101 , 102 ). Behavioral therapies are the standard of care with the strongest evidence in support of contingency management, a therapy that reinforces abstinence through incentivization ( 98 ). In AshaRani et al ( 103 ) review of 44 studies, contingency management outperformed cognitive behavioral therapy (CBT) in selected studies, but used alone, both therapies were effective during treatment periods.…”

Section: Diagnostic Challenges and Managementmentioning

confidence: 99%

A review of methamphetamine use and stroke in the young

Hemphill,

Tierney,

Tirschwell

et al. 2024

Front. Neurol.

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Methamphetamine (meth) is a potent and addictive central nervous system stimulant with increasing use. Stroke is one severe possible complication of meth use. Due to high levels of manufacturing in Mexico, the western United States has experienced greater consequences of meth use. The literature reviewed herein is comprised of case studies and series, and it suggests that hemorrhagic stroke (including hypertensive-like intracerebral hemorrhage and aneurysmal subarachnoid hemorrhage), as opposed to ischemic stroke, is the more common type of neurovascular complication of meth use. Meth-related strokes are a particular concern for younger patients with stroke and may be a partial explanation for increasing stroke rates in this age group. We describe two cases (one intraparenchymal hemorrhage and one ischemic stroke) in young patients (<50 years old) with recent meth use to illustrate clinical characteristics and therapeutic considerations. There are several proposed pathophysiological explanations for meth-associated hemorrhagic stroke including an induced hypertensive surge, vasospasm, blood brain barrier breakdown, chronic hypertension, aneurysm development and rupture, and very rarely associated vasculitis. The increased risk of ischemic stroke related to meth use is less well supported in the literature, but this may, in part, be related to a lack of appropriately designed and powered research studies. Proposed mechanisms for ischemic stroke complications of meth use include those affecting blood vessels such as accelerated atherosclerosis, chronic hypertension, vasospasm, and vasculitis, plus mechanisms that affect the heart including cardiomyopathy, arrhythmias, and infective endocarditis (especially with injection drug use). Standard therapeutic interventions for acute stroke and approaches to secondary stroke prevention seem appropriate for meth-associated strokes, with the addition of abstinence from continued meth use. There is no evidence for any meth-specific stroke treatments. Finally, the prolonged duration of meth withdrawal is described. Larger, prospective studies of meth-related strokes are needed to allow for a better understanding and improved care for this often-devastating consequence of an increasingly prevalent cause of strokes in young patients.

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