Treatment of stimulant use disorder: A systematic review of reviews

Ronsley, Claire; Nolan, Seonaid; Knight, R. C.; Hayashi, Kanna; Klimas, Jan; Walley, Alex; Wood, Evan; Fairbairn, Nadia

doi:10.1371/journal.pone.0234809

Cited by 141 publications

(106 citation statements)

References 71 publications

(121 reference statements)

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“…Co-use of opioids and stimulants elevates fatal overdose risk and is associated with poorer medical, mental health, and substance use disorder treatment outcomes (16). Supporting increased access to medications for opioid use disorder ¶ ¶ ¶ ¶ ¶ and evidence-based treatments for stimulant use disorders (17) can help mitigate risks. Research into more effective treatments for co-occurring opioid and stimulant use disorder is also needed.…”

Section: Discussionmentioning

confidence: 99%

Vital Signs: Characteristics of Drug Overdose Deaths Involving Opioids and Stimulants — 24 States and the District of Columbia, January–June 2019

O’Donnell

Gladden

Mattson

et al. 2020

MMWR Morb. Mortal. Wkly. Rep.

209

127

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Introduction: Provisional estimates indicate that drug overdose deaths increased in 2019 after a slight decrease in 2018. In 2018, overdose deaths primarily involved opioids, with continued increases in deaths involving illicitly manufactured fentanyls (IMFs). Deaths involving stimulants such as cocaine and methamphetamine are also increasing, mainly in combination with opioids. Methods: CDC analyzed data on drug overdose deaths during January-June 2019 from 24 states and the District of Columbia (DC) in the State Unintentional Drug Overdose Reporting System to describe characteristics and circumstances of opioidand stimulant-involved overdose deaths. Results: Among 16,236 drug overdose deaths in 24 states and DC, 7,936 (48.9%) involved opioids without stimulants, 5,301 (32.6%) involved opioids and stimulants, 2,056 (12.7%) involved stimulants without opioids, and 943 (5.8%) involved neither opioids nor stimulants. Approximately 80% of overdose deaths involved one or more opioid, and IMFs were involved in three of four opioid-involved overdose deaths. IMFs, heroin, cocaine, or methamphetamine (alone or in combination) were involved in 83.8% of overdose deaths. More than three in five (62.7%) overdose deaths had documentation of at least one potential opportunity for overdose prevention intervention. Conclusions and implications for public health practice: Identifying opportunities to intervene before an overdose death and implementing evidence-based prevention policies, programs, and practices could save lives. Strategies should address characteristics of overdoses involving IMFs, such as rapid overdose progression, as well as opioid and stimulant co-involvement. These efforts should be complemented by efforts to prevent initiation of prescription opioid and stimulant misuse and illicit drug use.

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Section: Discussionmentioning

confidence: 99%

Vital Signs: Characteristics of Drug Overdose Deaths Involving Opioids and Stimulants — 24 States and the District of Columbia, January–June 2019

O’Donnell

Gladden

Mattson

et al. 2020

MMWR Morb. Mortal. Wkly. Rep.

209

127

View full text Add to dashboard Cite

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“…Unfortunately for the emerging 'twin epidemic' scenario, the existent toolbox of available, feasible and especially effective intervention options for psychostimulants has presented itself as considerably more limited than that for opioids [47,93]. For treatmentthis in categorical contrast of opioids where opioid-based pharmacotherapy forms the essential, and 'gold standard' core of treatment [94,95] no medications have been approved, available or have been found convincingly effective for the treatment of either cocaine or amphetamine dependence/disorder, regardless if focusing on withdrawal, abstinence or relapse as main intervention aims [47,[96][97][98]. A very recent RCT utilizing injectable naltrexone combined with bupropion for methamphetamine use disorder found a relatively higher response rate for the treatment intervention compared to placebo controls, yet a low overall treatment effect (11.1%) [99].…”

Section: Implications For Interventionsmentioning

confidence: 99%

“…The current standard of care for psycho-stimulant dependence treatment primarily involves on psycho-social interventions; however, their effectiveness is limited and commonly does not produce better outcomes than usual care [47,103,104]. As somewhat of an exception, the therapeutic application of contingency management intervention components has shown some therapeutic effects towards reducing psycho-stimulant use levels [96,[105][106][107]; however, this intervention-type is not broadly feasible nor widely implemented in many treatment settings, and so not widely applicable. Beyond the fundamental efficacy for current or prospective treatment options, a systematic review examining barriers to treatment for individuals with methamphetamine use, many expressed low confidence in and reservations regarding the utility and effectiveness of available stimulant treatment options [108].…”

Section: Implications For Interventionsmentioning

confidence: 99%

“…Overall, even considering recentabstract and practicaladvances for psycho-stimulant treatment and prevention efforts, it is evident that available options and their effectiveness remain highly limited [47,93,96]. Even the more longstanding and broader range and toolbox of interventions for opioid use has proven rather limited in its utility and impact towards reducing the main (e.g., mortality/morbidity) harms, and adverse toll on public health [35,46].…”

Section: Implications For Interventionsmentioning

confidence: 99%

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‘Resurgent’, ‘twin’ or ‘silent’ epidemic? A select data overview and observations on increasing psycho-stimulant use and harms in North America

Fischer

O’Keefe-Markman

Lee

et al. 2021

Subst Abuse Treat Prev Policy

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In the early 2000s, increasing prevalence of psycho-stimulant (e.g., crack/cocaine, methamphetamine) use and related harms, including severe adverse health outcomes, was observed among - mostly marginalized - populations of persons using illicit drugs in North America, underscoring an urgent need for interventions options towards improved prevention and treatment. By about 2010, however, the ‘opioid crisis’, featuring unprecedented use and public health burden, had accelerated into full force in North America, largely muting attention to the psycho-stimulant issue until recently. Recent surveillance data on drug use and related mortality/morbidity from the present decade has documented a marked resurgence of psycho-stimulant use and harms especially in at-risk populations, commonly in direct combination with opioids, across North America, resulting in a ‘twin epidemic’ comprised of opioids and psycho-stimulants We briefly review select epidemiological data indicators for these developments from the United States and Canada; in the latter jurisdiction, related evidence has been less prevalent and systematic but corroborating the same trends. Evidently, the (widely ongoing) focus on the ‘opioid epidemic’ as a ‘mono-type’ drug problem has become an anachronism that requires urgent and appropriate correction. We then briefly consider existing, evidence-based options for – prevention and treatment – interventions targeting psycho-stimulant use and harms, which are substantially more limited and/or less efficacious than those available for problematic opioid use, while presenting major gaps and challenges. The observed resurgence of psycho-stimulants may, indirectly, relate to recent efforts towards curtailing (medical) opioid availability, thereby accelerating demand and supply for both illicit opioids and psycho-stimulants. The presently unfolding ‘twin epidemic’ of opioids and psycho-stimulants, combined with limited intervention resources, presents an acute challenge for public health and may crucially undermine actively extensive efforts to reduce opioid-related health harms in North America.

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“…While we do not make any claim to completeness regarding the literature analyzed for this opinion piece, we reviewed all obtainable systematic reviews and meta‐analyses on pharmacological treatments for CUD. A recent systematic review of reviews was used to identify those published until November 2019 [62]. A separate systematic search of peer‐reviewed articles published between November 2019 and July 2020 was conducted via Pubmed, EMBASE and the Cochrane Database, using the same keyword search terms as those of the aforementioned systematic review of reviews.…”

Section: Current Approaches To Treating Cudmentioning

confidence: 99%

Pharmacotherapeutic strategies for treating cocaine use disorder—what do we have to offer?

et al. 2020

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Background Cocaine use contines to be a significant public health problem world‐wide. However, despite substantial research efforts, no pharmacotherapies are approved for the treatment of cocaine use disorder (CUD). Argument Studies have identified positive signals for a range of medications for treating CUD. These include long‐acting amphetamine formulations, modafinil, topiramate, doxazosin and combined topiramate and mixed amphetamine salts extended‐release (MAS‐ER). However, valid conclusions about a medication's clinical efficacy require nuanced approaches that take into account behavioural phenotypes of the target population (frequency of use, co‐abuse of cocaine and other substances, genetic subgroups, psychiatric comorbidity), variables related to the medication (dose, short‐/long‐acting formulations, titration speed, medication adherence) and other factors that may affect treatment outcomes. Meta‐analyses frequently do not account for these co‐varying factors, which contributes to a somewhat nihilistic view on pharmacotherapeutic options for CUD. In addition, the predominant focus on abstinence, which is difficult for most patients to achieve, may overshadow more nuanced therapeutic signals. Conclusion While there is an emphasis on finding new medications with novel mechanisms of action for treating CUD, currently available medications deserve further investigation based on the existing literature. Evaluating refined metrics of treatment success in well‐defined subgroups of patients, and further exploring combination therapies and their synergy with behavioural/psychosocial interventions, are promising avenues to establishing effective therapies for CUD.

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Treatment of stimulant use disorder: A systematic review of reviews

Cited by 141 publications

References 71 publications

Vital Signs: Characteristics of Drug Overdose Deaths Involving Opioids and Stimulants — 24 States and the District of Columbia, January–June 2019

Vital Signs: Characteristics of Drug Overdose Deaths Involving Opioids and Stimulants — 24 States and the District of Columbia, January–June 2019

‘Resurgent’, ‘twin’ or ‘silent’ epidemic? A select data overview and observations on increasing psycho-stimulant use and harms in North America

Pharmacotherapeutic strategies for treating cocaine use disorder—what do we have to offer?

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