Pharmacotherapy of amphetamine‐type stimulant dependence: An update

Abstract

Issues Methamphetamine or amphetamine-type stimulants are the second most frequently used illicit drug worldwide, second only to cannabis. Behavioural treatments are efficacious, but their impact is limited underscoring the need for other treatment options, notably, pharmacotherapy. Approach A review of randomised controlled trials of pharmacotherapies for methamphetamine or amphetamine-type stimulants was performed using PubMed and Google Scholar databases. Evidence for efficacy of medications is reported. Key findings Clinical trials have yielded no broadly effective pharmacotherapy. Promising signals have been observed for methylphenidate, naltrexone, bupropion and mirtazapine in subgroups of patients in reducing stimulant use (e.g. patients with less severe dependence at baseline, men who have sex with men), though none has produced an unambiguous, replicable signal of efficacy. Implications Problems in Phase II trials, including high drop-out rates, missing data and a lack of agreement on outcomes, complicate efforts to find a broadly effective pharmacotherapy for amphetamine-type stimulant disorders. Efforts to address these problems include calls for better validation of pharmacological target exposure, receptor binding and functional modulation. As well, there is a need for agreement in using findings from pre-clinical and early phases of the medication development process for selecting better pharmacotherapy candidates. Conclusion After over 20 years of efforts worldwide to develop a broadly effective medication for dependence on methamphetamine or amphetamine-type stimulants, no candidate has emerged. This highlights the need for new compounds, consistent and stringent research methods, better integration between preclinical and clinical stages of medication development, and improved collaboration between government, industry and researchers.

Psychostimulants

“…However, abstinence was significantly higher in those individuals with high medication adherence compared to those with low adherence in a patient population with low methamphetamine abuse (Heinzerling et al, 2014). Together, these findings suggest that a high degree of personalization and management is needed (Brensilver, Heinzerling, & Shoptaw, 2013). A trial in adolescent methamphetamine abusers/dependent individuals did support bupropion as a treatment for this subpopulation of patients .…”

Amphetamine Type Stimulants Use in the Adult Population of Tehran: Implications for Long Term Rehabilitation

“…Studies have shown no broadly effective pharmacotherapy for treating ATS dependence [7]. Some studies show that methylphenidate, naltrexone, bupropion and mirtazapine are moderately effective for a few subgroups of patients in reducing stimulant use (e.g.…”

The Effects of Naltrexone on Subjective Response to Methamphetamine in a Clinical Sample: a Double-Blind, Placebo-Controlled Laboratory Study

“…Efficacious pharmacotherapies for MA use disorder remain elusive despite extensive research on the neurobiology of the effects of amphetamines (Brensilver et al, 2013;Elkashef et al, 2008). Naltrexone (NTX) is an opioid receptor antagonist with empirically supported efficacy and FDA approval for the treatment of alcoholism (Anton et al, 2006;O'Malley et al, 1992;Volpicelli et al, 1992) and opioid dependence (Cornish et al, 1997).…”