Promising results from the third stage of a clinical trial testing a medication combination to treat methamphetamine use disorder (MUD) are arriving at a critical time.
Meth-involved deaths have continued to rise across the country, with Indigenous people most impacted. But meth users may be one step closer to a Food and Drug Administration-approved treatment—a common antidepressant taken alongside an addiction medication, which has been reported by clinical researchers to help reduce patients’ use.
Daily doses of oral antidepressant bupropion coupled with injections every three weeks of naltrexone, a medication usually used to treat opioid or alcohol use disorders, was shown to help patients with moderate to severe MUD mitigate cravings.
Although this is far from the first time these medications have been tested with the aim of treating MUD, the well-evidenced efficacy shown by a recent trial puts the scientific community that much closer to becoming the first treatment approved by the FDA for the purpose of treating MUD.
The buproprion/naltrexone combination reduced participants’ use of meth and resulted in overall life improvements, according to the study, which was published by The New England Journal of Medicine and funded by the federal National Institute on Drug Abuse (NIDA). All 400-plus participants in the study wanted to reduce or stop their meth use.
Bupropion is suggested to reduce cravings, while naltrexone might reduce the euphoric effects of meth.
Participants were considered to have successfully responded to treatment if they returned three negative urine screens out of four total. A higher rate of participants on the medication responded to the treatment than those who were not taking it. For weeks five and six, 16.5 percent of those given the naltrexone/bupropion combination responded, compared to only 3.4 percent of those in the control group. In weeks 11 and 12 of the treatment course, 11.4 percent of the medicated group responded, compared to 1.8 percent of the control group.
Bupropion is suggested to reduce cravings, while naltrexone might reduce the euphoric effects of meth. In the study, researchers wrote that the combination’s “benefit as a treatment for methamphetamine use disorder is similar to most medical treatments for mental health disorders, including antidepressants prescribed for depression or naltrexone prescribed for alcohol use disorder.” No significant adverse effects were identified.
“The opioid crisis and resulting overdose deaths in the United States are now well known, but what is less recognized is that there is a growing crisis of overdose deaths involving methamphetamine and other stimulants. However, unlike for opioids, there are currently no approved medications for treating methamphetamine use disorder,” said NIDA director Dr. Nora Volkow in a statement. “This advance demonstrates that medical treatment for methamphetamine use disorder can help improve patient outcomes.”
The bupropion/naltrexone combination seems to be a promising resource for people struggling to manage their meth use. But pharmacological treatment is only part of a comprehensive response to potential drug harms. To protect against meth-involved overdoses, known as overamps, harm reductionists recommend checking your bag for unexpected substances, like fentanyl, taking breaks and getting sleep, eating nourishing food and staying hydrated and staying on top of your heart and blood-pressure health.
Meth-involved overamp deaths “surged” between 2011 and 2018, according to NIDA. Overamps spiked most sharply among “non-Hispanic American Indian and Alaska Natives,” the agency wrote in a press release. For these populations, the rate rose from 4.5 to 20.9 per 100,000 people.
“While much attention is focused on the opioid crisis, a methamphetamine crisis has been quietly, but actively, gaining steam—particularly among American Indians and Alaska Natives, who are disproportionately affected by a number of health conditions,” Volkow, a senior author on NIDA’s mortality study, continued in the statement.
Just as MUD medication is only part of the solution to the overdose crisis, knowing who needs the most support is also crucial.
“Identifying populations that have a higher rate of methamphetamine overdose is a crucial step toward curbing the underlying methamphetamine crisis,” said Dr. Beth Han, a NIDA investigator, in the same statement. “By focusing on the unique needs of individuals and developing culturally tailored interventions, we can begin to move away from one-size-fits-all approaches and toward more effective, tailored interventions.”
Because the promising combo for MUD is not yet approved by the FDA, patients could try accessing treatment by speaking with their medical provider about the off-label prescription of bupropion and naltrexone. What remains to be seen is if or when this medication combo will become a viable low-threshold treatment for the majority of people who could benefit from it.
Photograph of crystal methamphetamine by Radspunk via Wikimedia Commons/Creative Commons 4.0