Evidence-Based Guidelines for the Pharmacologic Management of Methamphetamine Dependence, Relapse Prevention, Chronic Methamphetamine-Related, and Comorbid Psychiatric Disorders in Post-Acute Settings

Abstract

The increasing abuse of the street drug crystal meth (methamphetamine) in many countries worldwide has resulted in a growing demand to treat patients who have acquired a methamphetamine-related disorder. The results of a systematic literature search which led to the consensus-based recommendations by the Working Group of the German Agency for Quality in Medicine (Ärztliches Zentrum für Qualität in der Medizin - ÄZQ) are presented. Pharmacological treatments were reviewed in 58 out of the 103 publications included. They were mainly randomized controlled trials (RCT). Despite increased research activities, none of the medications studied demonstrated a convincing and consistent effect on abstinence rates, despite some having an impact on craving and retention rates or symptom control. In addition, as yet there is no sufficient evidence available for dopamine analogue treatment ("substitution") after the initial withdrawal-period. Methamphetamine-related, post-acute persistent or comorbid syndromes such as methamphetamine-associated psychosis (MAP), depressive syndromes, anxiety, and sleep disorders are usually treated in a symptom-oriented manner. Risks of interactions with methamphetamine have to be taken in account when prescribing medications with doubtful efficacy. Further research is warranted.

Evaluation of Amphetamine-Related Hospitalizations and Associated Clinical Outcomes and Costs in the United States

“…Public health responses that address the socioeconomic factors in addiction are needed, particularly because no pharmacologic options exist for the treatment of amphetamine use disorders. 31 …”

“… 36 However, to our knowledge, no such data exist for amphetamine use disorders, in part, because effective medication for amphetamine use disorder does not exist. 31 Behavioral therapies, contingency management in particular, are the only treatments currently available for amphetamine use disorder, but their efficacy is rarely sustained. 37 , 38 , 39 As such, the public health approach proposed by experts to combat the opioid epidemic may also prove useful if expanded to include other substances, such as amphetamines.…”

A Research of Methamphetamine Induced Psychosis in 1,430 Individuals With Methamphetamine Use Disorder: Clinical Features and Possible Risk Factors

“…Gradually, those severe patients are out of touch with society, and finally the social function is completely lost ( 11 ). Therefore, it may be considered to be necessary for participants with MIP to obtain the antipsychotic medications ( 12 ).…”

Update on methamphetamine: an old problem that we have recently encountered

“…The drugs studied for methamphetamine-use disorder include acetylcysteine, antidepressants, antiepileptic drugs, atypical antipsychotic drugs, calcium antagonists, muscle relaxants, opioid antagonists, psychostimulants, and varenicline (9). Methamphetamine-related persistent or comorbid syndromes such as methamphetamineassociated psychosis, depressive syndromes, anxiety, and sleep disorders are usually treated in a symptomoriented manner (57).…”

“…Unlike opiate treatment with opiate analogues, dopamine-analogue treatment has not yet produced convincing results (57). A recent systematic review found no effect of psychostimulant agents on sustained abstinence or retention in treatment (58).…”