Responding to global stimulant use: challenges and opportunities

Farrell, Michael; Martin, Natasha K.; Stockings, Emily; Bórquez, Annick; Cepeda, Javier; Degenhardt, Louisa; Ali, Robert; Tran, Lucy Thi; Rehm, Jürgen; Torrens, Marta; Shoptaw, Steven; McKetin, Rebecca

doi:10.1016/s0140-6736(19)32230-5

Cited by 232 publications

(220 citation statements)

References 124 publications

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“…Recurrent stimulant use in situations where it is physically hazardous 9. Stimulant use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the stimulant 10. Tolerance, as defined by either of the following: a.…”

Section: Key Pointsmentioning

confidence: 99%

“…Globally, it is estimated that 7.4 million people are dependent on amphetamines, and that dependence affects 11% of people who use amphetamines [10]. Regular or dependent AMPH/MA use is associated with comorbidities including depression, anxiety, psychosis and cardiovascular disease, and is due to contextual social factors related to the consumption of AMPH/MA, sexually transmitted infections or blood borne viruses and legal issues [11,12].…”

Section: Introductionmentioning

confidence: 99%

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Pharmacological Treatment of Methamphetamine/Amphetamine Dependence: A Systematic Review

et al. 2020

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Background Stimulant drugs are second only to cannabis as the most widely used class of illicit drug globally, accounting for 68 million past-year consumers. Dependence on amphetamines (AMPH) or methamphetamine (MA) is a growing global concern. Yet, there is no established pharmacotherapy for AMPH/MA dependence. A comprehensive assessment of the research literature on pharmacotherapy for AMPH/MA dependence may inform treatment guidelines and future research directions. Methods 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. We included all studies published to 19 June 2019. The selected studies were evaluated for design; methodology; inclusion and exclusion criteria; sample size; pharmacological and (if included) psychosocial interventions; length of follow-up and follow-up schedules; outcome variables and measures; results; overall conclusions and risk of bias. Outcome measures were any reported impact of treatment related to AMPH/MA use. Results Our search returned 43 studies that met our criteria, collectively enrolling 4065 participants and reporting on 23 individual pharmacotherapies, alone or in combination. Disparate outcomes and measures (n = 55 for the primary outcomes) across studies did not allow for meta-analyses. Some studies demonstrated mixed or weak positive signals (often in defined populations, e.g. men who have sex with men), with some variation in efficacy signals dependent on baseline frequency of AMPH/MA use. The most consistent positive findings have been demonstrated with stimulant agonist treatment (dexamphetamine and methylphenidate), naltrexone and topiramate. Less consistent benefits have been shown with the antidepressants bupropion and mirtazapine, the glutamatergic agent riluzole and the corticotropin releasing factor (CRF-1) antagonist pexacerfont; whilst in general, antidepressant medications (e.g. selective serotonin reuptake inhibitors [SSRIs], tricyclic antidepressants [TCAs]) have not been effective in reducing AMPH/MA use. Conclusions No pharmacotherapy yielded convincing results for the treatment of AMPH/MA dependence; mostly studies were underpowered and had low treatment completion rates. However, there were positive signals from several agents that warrant further investigation in larger scale studies; agonist therapies show promise. Common outcome measures should include change in use days. Future research must address the heterogeneity of AMPH/MA dependence (e.g. coexisting conditions, severity of disorder, differences between MA and AMPH dependence) and the role of psychosocial intervention.

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Section: Key Pointsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Pharmacological Treatment of Methamphetamine/Amphetamine Dependence: A Systematic Review

et al. 2020

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“…Although these findings are instructive, they are limited in their generalizability due to the small sample size; nor do they reflect newer risks associated with contamination of the illicit drug supply with fentanyl and fentanyl analogues. Similar to the case of stimulant‐related harm reduction interventions in general , additional research on strategies to optimize the utility and encourage the uptake of safer methamphetamine smoking kits is urgently needed. However, ongoing research should not preclude efforts on the ground.…”

Section: Declarations Of Interestsmentioning

confidence: 99%

“…However, ongoing research should not preclude efforts on the ground. In the present ‘fourth wave’ of the opioid crisis that features rising methamphetamine consumption, public health authorities throughout North America need to be proactive in their response by incorporating a range of harm reduction interventions to mitigate additional drug‐related harms, especially as effective treatment options for stimulant‐related problems are limited , Part of that public health response should include enabling and facilitating access to safer methamphetamine smoking kits, given the potential for improvements in health outcomes.…”

Section: Declarations Of Interestsmentioning

confidence: 99%

Safer smoking kits for methamphetamine consumption

et al. 2020

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“…The use of and harms related to methamphetamine are a global concern . We applaud Imtiaz and colleagues for their focus on methamphetamine smoking risks and recommend consideration of an even broader range of approaches to reducing the impact of methamphetamine use.…”

mentioning

confidence: 99%