Rx Stimulants for Methamphetamine Addiction? Good idea?

Hi and welcome back. Dr. Heinzerling here again. In response to our last entry, several people have asked, "What about using prescription stimulants to treat methamphetamine addiction?" GREAT IDEA and one with precedent. Nicotine replacement (patches) is used for smoking cessation treatment and methadone and buprenorphine (Suboxone) are approved to treat opioid addiction. This approach is called SUBSTITUTION THERAPY.

Several studies have assessed this approach for stimulant addiction. A randomized, placebo controlled trial tested oral sustained-release methamphetamine (pharmaceutical tablets not street methamphetamine) for treating cocaine addiction. Cocaine use was lower in patients receiving oral methamphetamine compared to those receiving placebo (60% of urine tests positive for cocaine in placebo group compared to 20% positive in sustained-release methamphetamine patients). A different study tested oral sustained-release d-amphetamine for methamphetamine addiction. Patients getting d-amphetamine had lower cravings and withdrawal symptoms but did not use less methamphetamine (the dose of d-amphetamine was relatively low and higher doses may have better results). So it seems that substitution treatment DOES have some beneficial effects in stimulant addiction, although it may be better at reducing drug use than stopping it completely.

The main issue with the substitution approach is the potential dangers of giving strong prescription stimulants to patients addicted to stimulants (e.g heart attack or stroke if combined with high doses of illicit stimulants). While this has not been observed in the clinical trials, it is likely that prescribing of stimulants for cocaine or methamphetamine addiction would be limited to highly controlled and supervised settings (think methadone clinics). As a result, we are focusing on developing potential medications expected to have a wider margin of safety such that they could eventually be prescribed by doctors in regular clinic offices (more like Suboxone than methadone). Despite this, the substitution approach still may have relevance for some patients, especially the most severely addicted patients who would benefit from intensive monitoring or those who have failed other treatment approaches and research is continuing! Thanks for reading and questions/comments are always welcome (easy to do via our Twitter feed!).



Tags: cocaine, crystal meth, methadone, methamphetamine, stimulants, suboxone, substitition treatment