ANMethamphetamine overdose rates skyrocket in the United States, one of the biggest challenges for both people using stimulants and doctors is that there are no approved treatments for this type of addiction – unlike the three drugs authorized to treat opioid use disorders.
But in a new study, the researchers found that a combination of two existing drugs – one, a treatment for opioid addiction and the other, an antidepressant – may help some people who regularly use methamphetamine to reduce it. In a clinical trial, the researchers reported Wednesday, 13.6% of participants treated with the two drugs repeated urine tests without methamphetamine, compared with just 2.5% of those who received placebos.
“This is a very serious disease with fatal consequences for which there are no treatments available,” said Madhukar Trivedi, head of the mood disorders division at the Southwestern Medical Center at the University of Texas and lead author of the article, which was published in The New English medical journal. “There is hope now for the meth use disorder.”
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Some experts not involved in the study were also enthusiastic.
“Methamphetamine disorder is a really difficult disorder to treat and a really devastating disease,” said Miriam Komaromy, medical director of the Grayken Center for Addiction at Boston Medical Center. “This study provides one of the few medication tools that we have reason to believe is useful for treating meth use disorder, so I’m really excited.”
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The two drugs used in the study were injectable naltrexone and oral bupropion. The first is a treatment for the opioid use disorder – it is better known by the brand Vivitrol – and is also used for alcoholism. The latter is an antidepressant and medication to stop smoking.
Some outside experts said they would like to see long-term data, beyond the 12-week study, to see what lasting benefits the drugs offer. And Ayana Jordan, a psychiatrist addicted to Yale University, said she would like more information about the different types of results, such as whether treatments improved people’s social connection or ability to work, even if they didn’t stop using meth. complete.
She also said that while it is useful to have data indicating that this combined treatment can help some people, the findings underscore the need for better drugs that can help more patients. “It is easier to have a more optimistic outlook because we have nothing that works now,” said Jordan.
Since scientists were unable to develop specific treatments for methamphetamine addiction, doctors turned to existing drugs to see what could be of benefit. A 2019 clinical trial, for example, found that another antidepressant called mirtazapine helped some people reduce their use of methamphetamine.
Doctors can prescribe drugs already approved by the Food and Drug Administration for other “off-label” purposes to try to treat meth addiction. But experts say that having clinical trial data validates the approach and can also help convince payers to cover drugs.
In recent years, the country has started to fight more against the addiction crisis, although much of the attention has turned to opioids, which cause the greatest number of fatal overdoses. But, quietly, deaths from overdose of stimulants, including cocaine and methamphetamine, have increased. In the 12-month period ending in June 2020, for example, there were more than 19,600 methamphetamine deaths, according to preliminary federal data. In 2016, there were 6,700. (Many overdose deaths involve several medications.)
The new clinical trial started with more than 400 patients who used meth on a regular basis. In a first stage, patients were randomized to receive the drugs or the placebo. Then, those in the placebo group who did not respond initially were randomized again, to remain on the placebo or to start treatments. Together, 13.6% of people who received treatments in either round had at least three negative urine tests in four at the end of the trial stages, versus 2.5% of people who received placebos.
Men represented about two-thirds of the participants. Whites represented about 71% of participants, while 12% were black and 13.6% identified as Latino or Hispanic.
The study had a “necessary to treat” number of nine, which means that nine patients would have to receive the drugs in order for one to have a positive response. Although that number may seem low, experts say the study’s results are close to the effectiveness of treatments for other types of addiction, such as alcohol and tobacco. The exceptions, experts say, are methadone and buprenorphine, which have shown much higher levels of success in treating opioid use disorder.
One of the challenges of using naltrexone to treat opioid addiction is that, due to the way the drug works in the brain, people cannot have used opioids for several days before receiving the injection. Otherwise, naltrexone can cause debilitating withdrawal symptoms.
But since methamphetamine interacts with the brain differently from opioids, people who use methamphetamine but not opioids should be able to be treated with naltrexone without having to wait, said Trivedi, who also advises pharmaceutical companies, including Alkermes, Vivitrol manufacturer.
Doctors don’t just rely on drugs to treat addiction. Behavioral therapies, such as counseling, are also often involved. And with stimulants in particular, a practice called contingency management, which pays people or provides other rewards if they remain abstinent, has been shown to be effective.
Stefan Kertesz, an addiction doctor at the University of Alabama at Birmingham, who was not involved in the new clinical trial, said he could imagine offering the combination of drugs to patients who expressed a desire to stop using meth, while also recommending therapies like contingency management.
“This new study suggests that for people with meth use disorder who are starting a very challenging recovery process, a combination of medications can increase their chances of success,” wrote Kertesz by email. “And that is promising.”