“Methadone” for Meth Is on the Horizon

December 17, 2019

The robust public health response to opioid use disorders in the United States is, in part, made possible by the availability of methadone and buprenorphine. But as methamphetamine-involved deaths rise amid increasing fentanyl adulteration of street supplies, the lack of a substitution medication for meth (although medications like Adderall are very similar) has left responders empty-handed.

One anti-depressant could be the key to ending the scarcity of meth use disorder treatments, San Francisco researchers found in a clinic trial published in JAMA Psychiatry on December 11. The medication mirtazapine was shown to reduce meth use and accompanying risky sexual behaviors over the course of six months among gay men and transgender women. The researchers suggest that it could aid in quelling cravings and withdrawal symptoms.

Compared to the placebo group in the trial, the urine of those taking mirtazapine decreasingly tested positive for meth over time, and they had fewer sexual partners and fewer experiences of condom-less anal sex with a partner who had a different HIV status.

These “promising” results, as one prominent harm reduction advocate tweeted, were even found despite participants displaying “suboptimal medication adherence.” (Although not the same, adherence to antiretroviral therapy for HIV is also shaky among people who use meth.)

Regardless of these obstacles and limitations, mirtazapine could provide people with more options for managing their meth use. “Although the impact of mirtazapine was modest, these results provide a sign of real hope for people who want to reduce or stop methamphetamine use,” Phillip O. Coffin, MDof the San Francisco Department of Public Health, told Healio Psychiatry. “Mirtazapine, probably in combination with behavioral interventions, would be expected to help many people and opens the doors to future medication development.”

Other existing medications, like the opioid antagonist naltrexone, have been suggested as possibilities for meth use disorder treatment.

Photo of mirtzapine by Żółwiciel via Wikimedia Commons

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