A US government-funded study has provided evidence of a hopeful treatment for people struggling with methamphetamine 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 all the more encouraging because the methamphetamine use disorder is extremely difficult to treat.
In recent years, the drug overdose crisis has only gotten worse. There were more than 70,000 deaths from overdose in 2019, and 2020 is strongly expected to be worse, thanks in part to the Covid-19 pandemic. Much attention has been paid to opioids before the crisis, but it has become clear that abuse of other drugs – including stimulants such as methamphetamine – is also on the rise.
While it is difficult for many people struggling with drug addiction to find help, treatments are available for opioid use and alcohol use disorders, as well as smoking cessation. These include drugs that reduce cravings and withdrawal symptoms that can be combined with counseling and therapy. However, to date there are no known drugs that reduce these symptoms specifically for meth use.
This new study, published Wednesday in the New England Journal of Medicine, tested a combination of two medications: bupropion, an antidepressant and smoking cessation aid, as well as naltrexone, which is used to treat opioids and alcohol use disorders.
The study involved 403 volunteers with moderate to severe methamphetamine use disorder who were randomized to the treatment group or placebo. A second round of the study, involving people from the placebo group who did not respond to treatment, was conducted with 225 volunteers. Those in the treatment group received an injection of naltrexone and a daily pill of bupropion every three weeks, then followed for six weeks. Participants in both groups met weekly with clinicians and received counseling; they also had their urine tested for meth.
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Across the two studies, the percentage of people who responded to treatment (defined as testing negative for meth at least three times out of four) was low for both groups. But it was noticeably higher for people on the drug combination. On average, 13.6% of those taking bupropion and naltrexone responded to treatment, compared to 2.5% of those taking placebo. In surveys the volunteers took, those in the experimental group seemed to report less cravings and greater improvement in quality of life during the trial period, although the researchers caution that these findings are less certain. There were no serious side effects associated with the treatment, but users showed a higher risk of nausea, vomiting and constipation compared to the placebo group.
The benefits of this combination therapy are likely modest at best. But the authors note that the level of improvement seen in this study is roughly equivalent to other established treatments for some mental health and substance use disorders, including an unhealthy alcohol addiction. If nothing else, it could be the first evidence-based medication for methamphetamine use disorder, a serious illness that can lead to long-term health complications such as heart and brain damage, but also hallucinations, paranoia, and severe tooth decay and loss.
“These advances show that medical treatment for methamphetamine use disorder can help improve patient outcomes,” said Nora Volkow, director of the National Institute on Drug Abuse, which helped conduct the study, in a statement. statement released by the federal agency.
While the study paves the way for this combination therapy to be widely used for these patients, future studies will need to test how effective it can be in more realistic settings and for longer periods of time, the authors wrote.