A study funded by the US government provided evidence of promising treatment for people struggling with meth use. People who received combination drug therapy were more likely to avoid the drug and report improvements in their lives than those who received standard support and placebo, the study found. The findings are even more encouraging because the meth use disorder is especially difficult to treat.
In recent years, the drug overdose crisis has only worsened. There were more than 70,000 overdose-related deaths in 2019, and 2020 is strongly expected to have been worse, in part thanks to the covid-19 pandemic. Much of the focus of the crisis has been on opioids, but it has become apparent that abuse of other drugs – including stimulants like meth – is also on the rise.
While it is difficult for many people struggling with drug addiction to find help, there are treatments available for opioid use and alcohol use disorder, as well as for stopping smoking. This includes drugs that reduce cravings and withdrawal symptoms, which can be combined with counseling and therapy. So far, however, there are no known drugs to reduce these symptoms specifically for methamphetamine use.
This new study, Published Wednesday in the New England Journal of Medicine, he tested a combination of two drugs: bupropion, an antidepressant and a quit smoking aid, as well as naltrexone, used to help treat the opioid and alcohol use disorder.
The study involved 403 volunteers with moderate to severe meth use disorder who were randomized to the treatment or placebo group. A second round of the trial, involving people in the placebo group who did not respond to treatment, was conducted with 225 volunteers. Those in the treatment group received an injection of naltrexone every three weeks and a daily pill of bupropion, then were monitored for six weeks. Participants from both groups met with doctors weekly and received counseling; they also had their urine tested for methamphetamine.
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In both trials, the percentage of people who responded to treatment (defined as a negative methamphetamine test at least three times out of four) was low for both groups. But it was noticeably higher for people who took medication. On average, 13.6% of people who took bupropion and naltrexone responded to treatment, compared with 2.5% of people who took placebo. In surveys the volunteers did, those in the experimental group seemed to report less desire and a greater improvement in quality of life over the duration of the trial, although the researchers caution that these findings are less certain. There were no serious adverse effects associated with treatment, but users showed an increased risk of nausea, vomiting and constipation compared to the placebo group.
The benefits of this combination therapy are likely to be modest, at best. But the authors note that the level of improvement seen in this study is roughly similar to other treatments established for some mental health disorders and substance use, including an addiction to alcohol that is harmful to health. At the very least, it could represent the first evidence-based medication for methamphetamine use disorder, a serious disease that can lead to health complications such as cardiac and brain damage, as well as hallucinations, paranoia and loss and severe tooth decay.
“This advance demonstrates that medical treatment for methamphetamine disorder can help improve patient outcomes,” said Nora Volkow, director of the National Drug Abuse Institute, who helped conduct the study, in a declaration released by the federal agency.
Although the study paves the way for this combination therapy to be widely used for these patients, future studies will have to test how effective it can be in more real environments and for long periods of time, the authors wrote.