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Are There Medications for Meth Addiction on the Horizon?

Methamphetamine, or meth, is a highly addictive and powerful stimulant drug that impacts the central nervous system (CNS).1 Second only to cannabis, stimulants like meth are some of the most widely used types of illicit drugs in the world.2

Currently, there are no FDA-approved medications for the treatment of meth use disorder, the clinical diagnosis for meth addiction.3 However, ongoing research shows the future of meth addiction treatment may involve one or more medications currently being studied.3

Pharmacotherapies Under Study for Meth Addiction

No pharmacotherapy has yielded overwhelmingly strong results in treating meth use disorder, however, there have been some positive findings that were significantly better than placebo outcomes. Research continues, and future studies are needed to focus on addressing the limitations and shortcomings of previous studies, including longer-term data, larger and more diverse sample sizes, and outcome measures that aren’t solely based on reduced meth use but also on things like improvements in social connectedness or ability to work.2 Provisional guidelines for treating stimulant use disorder from the American Society for Addiction Medicine and the American Academy of Addiction Society (ASAM/AAAP) include consideration of certain medications that have shown positive signals in early studies for reducing meth use in patients with meth use disorder.3

Bupropion for Meth Addiction Treatment

Bupropion is a dopamine and norepinephrine reuptake inhibitor medication marketed for various uses under brand names such as Wellbutrin. The ASAM/AAAP indicates bupropion may help promote meth abstinence in patients with meth use disorder and a low to moderate frequency of use (e.g., less than 18 days per month).3

Evidence shows that bupropion may be more effective for patients who do not use meth daily and can adhere to a regular medication regimen. In such cases, bupropion may help reduce the frequency of meth use (or other amphetamine-type stimulants).3

Currently, no data suggests any adverse effects of treatment with bupropion in patients with amphetamine-type use disorders, such as meth use disorder.3 While research indicates that both the wanted and unwanted effects of bupropion have been small, the ASAM/AAAP guidelines note the potential benefits of bupropion outweigh any potential risks. As there are currently no strongly supported medications to treat meth use disorder, the ASAM/AAAP indicates that treatment with bupropion is supported.3

Bupropion/Naltrexone Combination Therapy for Meth Addiction Treatment

People with a moderate to severe meth use disorder may benefit from bupropion in combination with naltrexone to help reduce meth use.3 Naltrexone is currently FDA-approved to treat alcohol use disorder and opioid use disorder.4  This may be a particularly useful combination in people struggling with meth use disorder and a co-occurring alcohol use disorder, as it can also help reduce alcohol use.3

Mirtazapine for Meth Addiction Treatment

The ASAM/AAAP indicates mirtazapine, an atypical antidepressant, may help promote a reduction in meth use.3

Research into the efficacy of mirtazapine for the treatment of meth use disorder is limited; however, two randomized controlled trials (RCTs) with mirtazapine showed a small reduction in amphetamine use when compared to treatment with a placebo.3 The studies, both conducted specifically with men who have sex with men, also showed a significant reduction in sexual risk behaviors and an improvement in sleep in patients treated with mirtazapine. As there are few supported medication options, the ASAM/AAAP indicates mirtazapine is preferable to no treatment at all in patients with meth use disorder, especially men who have sex with men—although the guidelines state these positive results can be extended to the general population of people with meth use disorder as well, particularly those with co-occurring depression.3

Topiramate for Meth Addiction Treatment

Topiramate, an anticonvulsant medication used to treat epilepsy, may help reduce meth use in patients with meth use disorder.3, 5

Existing evidence, though limited, is promising for topiramate’s benefits in reducing meth use. Two randomized controlled trials (RCTs) showed that topiramate reduced meth use (as evidenced by urine drug tests) when compared with treatment with a placebo.3 These trials also showed reductions in ASI scores (Addiction Severity Index, an assessment tool used to evaluate the severity of a person’s addiction and addiction-related impairments), which could indicate that topiramate may help reduce consequences and functional problems related to meth use disorder.3, 6

For patients struggling to reduce their meth use and who have a co-occurring alcohol use disorder, topiramate may also be useful, as evidence shows that topiramate helps reduce alcohol consumption.3, 7

Methylphenidate Formulations for Meth Addiction Treatment

A long-acting methylphenidate formulation is another potential medication that may help reduce meth use, particularly in patients with meth use disorder and with co-occurring attention-deficit/hyperactivity disorder (ADHD).3 According to the ASAM/AAAP, higher doses than those the FDA recommends for treating ADHD may be needed to also effectively treat meth use disorder, and given the known effects of methylphenidate on blood pressure, a cardiovascular screening is recommended prior to starting this pharmacotherapy.3

Lisdexamfetamine for Acute Meth Withdrawal

Although not included in the ASAM/AAAP provisional guidelines, researchers in Australia are considering lisdexamfetamine to treat symptoms of acute meth withdrawal.8 These symptoms include dysphoric mood, sleep disturbance, appetite changes, and vivid and unpleasant dreams. Withdrawal is often characterized by a “crash” phase of exhaustion or fatigue over hours or days that can last 2-4 weeks. These symptoms may be relieved by a return to meth use. Lisdexamfetamine is also an amphetamine-like stimulant, but it has unique properties that suggest a lower addiction liability, including a slower onset of action and inducing a less intense rewarding or reinforcing response. Early results suggest it may be a viable option to reduce the severity of meth withdrawal symptoms, thus aiding in both treatment retention and post-withdrawal treatment engagement.8

Non-Pharmacological Treatment Options for Meth Addiction

If you or a loved one are struggling to control methamphetamine use, meth use disorder treatment can help. As there are no FDA-approved medications for meth use disorder, treatment often involves non-pharmacological options, such as behavioral and psychosocial interventions.9

According to the National Institute on Drug Abuse (NIDA), behavioral therapies are the most effective methods for preventing and treating meth use.1 Behavioral therapies that have the most research support for meth use disorder include:3, 10

  • Contingency management (CM), which helps patients increase desirable behaviors by providing incentives, or tangible rewards, when targets are met. CM has the best effectiveness in the treatment of stimulant use disorders compared to any other intervention. Evidence is strong that it can increase treatment engagement and reduce stimulant use. It represents the current standard of care.2
  • Motivational interviewing (MI), which is designed to help patients identify problematic behaviors and increase motivation to change.
  • Community reinforcement approach (CRA), which is an individualized approach that helps encourage lifestyle changes that are consistent with a healthier, substance-free lifestyle. CRA can involve several components, such as couples or family therapy, vocational counseling, skills training, and mutual support group participation.
  • Cognitive behavioral therapy (CBT), which is effective for stimulant use disorders when combined with CM. CBT helps patients modify unhelpful thoughts and behaviors that contribute to substance misuse and teaches more adaptive ways of functioning.
  • Matrix Model, which is a comprehensive, evidence-based approach to addiction treatment that combines various therapeutic techniques, including cognitive-behavioral therapy, to help individuals recover from substance misuse.

Treatment may start with detox to provide monitoring and support during withdrawal. Following detox, patients may enter ongoing addiction treatment in an inpatient or outpatient setting.10 Treatment should be personalized to your unique needs. You will receive a comprehensive evaluation before entering treatment to ensure you receive the appropriate level of care.9

No matter how challenging things might seem right now, there is always hope. If you or a loved one are struggling, reach out to American Addiction Centers (AAC) at . Our caring and professional admissions navigators are available 24/7 and can help you understand your rehab options and answer any questions you may have about the treatment process. Calling is confidential and free, and there is no obligation to enter treatment.

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