Evidence-Based Guidelines for the Pharmacological Management of Acute Methamphetamine-Related Disorders and Toxicity

Wodarz, Norbert; Krampe-Scheidler, Anne; Christ, Michael; Fleischmann, Heribert; Looser, Winfried; Schoett, Katharina; Vilsmeier, Frank; Bothe, Lydia; Schaefer, Christof

doi:10.1055/s-0042-123752

Cited by 23 publications

(29 citation statements)

References 46 publications

(49 reference statements)

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“…Although there are no evidence-based pharmacotherapies for AMPH/MA withdrawal [74], standard of care generally includes symptomatic medications that target symptoms of withdrawal, including short-term use of benzodiazepines (e.g. diazepam) for anxiety, agitation and sleep disturbances, and antipsychotics (e.g.…”

Section: Treatment Of Withdrawal Symptomsmentioning

confidence: 99%

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Pharmacological Treatment of Methamphetamine/Amphetamine Dependence: A Systematic Review

et al. 2020

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Background Stimulant drugs are second only to cannabis as the most widely used class of illicit drug globally, accounting for 68 million past-year consumers. Dependence on amphetamines (AMPH) or methamphetamine (MA) is a growing global concern. Yet, there is no established pharmacotherapy for AMPH/MA dependence. A comprehensive assessment of the research literature on pharmacotherapy for AMPH/MA dependence may inform treatment guidelines and future research directions. Methods We systematically reviewed the peer-reviewed literature via the electronic databases PubMed, EMBASE, CINAHL and SCOPUS for randomised controlled trials reported in the English language examining a pharmacological treatment for AMPH/MA dependence or use disorder. We included all studies published to 19 June 2019. The selected studies were evaluated for design; methodology; inclusion and exclusion criteria; sample size; pharmacological and (if included) psychosocial interventions; length of follow-up and follow-up schedules; outcome variables and measures; results; overall conclusions and risk of bias. Outcome measures were any reported impact of treatment related to AMPH/MA use. Results Our search returned 43 studies that met our criteria, collectively enrolling 4065 participants and reporting on 23 individual pharmacotherapies, alone or in combination. Disparate outcomes and measures (n = 55 for the primary outcomes) across studies did not allow for meta-analyses. Some studies demonstrated mixed or weak positive signals (often in defined populations, e.g. men who have sex with men), with some variation in efficacy signals dependent on baseline frequency of AMPH/MA use. The most consistent positive findings have been demonstrated with stimulant agonist treatment (dexamphetamine and methylphenidate), naltrexone and topiramate. Less consistent benefits have been shown with the antidepressants bupropion and mirtazapine, the glutamatergic agent riluzole and the corticotropin releasing factor (CRF-1) antagonist pexacerfont; whilst in general, antidepressant medications (e.g. selective serotonin reuptake inhibitors [SSRIs], tricyclic antidepressants [TCAs]) have not been effective in reducing AMPH/MA use. Conclusions No pharmacotherapy yielded convincing results for the treatment of AMPH/MA dependence; mostly studies were underpowered and had low treatment completion rates. However, there were positive signals from several agents that warrant further investigation in larger scale studies; agonist therapies show promise. Common outcome measures should include change in use days. Future research must address the heterogeneity of AMPH/MA dependence (e.g. coexisting conditions, severity of disorder, differences between MA and AMPH dependence) and the role of psychosocial intervention.

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Section: Treatment Of Withdrawal Symptomsmentioning

confidence: 99%

“…diazepam) for anxiety, agitation and sleep disturbances, and antipsychotics (e.g. olanzapine) to manage any comorbid psychotic symptoms [74]. Research is required on pharmacotherapy of stimulant withdrawal.…”

Section: Treatment Of Withdrawal Symptomsmentioning

confidence: 99%

Pharmacological Treatment of Methamphetamine/Amphetamine Dependence: A Systematic Review

et al. 2020

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“…The areas that are most affected include parts of Saxony, Thuringia and Bavaria. Pharmacotherapy has shown limited effectiveness, making psychotherapeutic interventions the treatment of choice (7). These include cognitive behavioral therapy, motivational interviewing and contingency management, which aim to reduce drug use, positive urine samples and craving.…”

Section: Introductionmentioning

confidence: 99%

Neurocognitive Dysfunctions and Their Therapeutic Modulation in Patients With Methamphetamine Dependence: A Pilot Study

et al. 2020

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Aim: Methamphetamine (MA) abuse and dependence are increasing worldwide and are commonly associated with cognitive deficits. Some studies indicate that such impairments can improve if users become abstinent, but overall results remain inconclusive. Hence, we have performed a longitudinal case-control study investigating key surrogates for attention and impulsive decision-making before and after treatment. Methods: Thirty patients with MA dependence and 24 non-substance-abusing control participants were recruited. Groups were matched on age, sex and education. All subjects performed a baseline assessment to obtain neurocognitive measures of sustained attention and delay discounting. Patients subsequently participated in an MA-specific relapse prevention program including repeated monitoring of relapse status. After 3 months, participants of both groups were reevaluated for neurocognitive performance. Results: At baseline, MA patients showed a significantly higher number of omissions compared to controls, indicative of lower sustained attention. Interestingly, we observed a steep decrease of omissions in MA patients to control-group level post treatment. On the other hand, MA patients discounted delayed rewards significantly stronger than controls, indicating a more impulsive choice behavior both before and after treatment. Limitation: The results should be interpreted with care because of the small sample and short follow-up period. Conclusion: Our data support earlier findings on partial recovery of cognitive deficits in MA patients. They also strengthen the indication for recently recommended psychotherapeutic interventions and may provide a behavioral monitoring tool to inform treatment progress.

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“…Chemical restraint using titrated i.v. benzodiazepines is typically recommended . However, anti‐psychotics, such as droperidol, have been shown to be as effective but safer than benzodiazepines for the management of all forms of acute behavioural disturbance including stimulant toxicity.…”

Section: Introductionmentioning

confidence: 99%

Methamphetamine presentations to an emergency department: Management and complications

Isoardi

Ayles

Harris

et al. 2018

Emerg Medicine Australasia

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Objective: There is little recent published data characterising methamphetamine intoxication. The present study aims to describe the clinical effects, management, complications and disposition of patients with methamphetamine exposure. Methods: This is a retrospective review of patients presenting with methamphetamine intoxication to an ED in 2016. All presentations were extracted from a relational database and each medical record reviewed. Demographics, clinical features, complications and disposition were extracted. Results: There were 378 presentations of 329 patients (234 men [71%]), median age 31 years (range 16-68 years). The most common clinical effect was acute behavioural disturbance, occurring in 295 (78%) presentations. This was successfully managed with oral sedation alone in 180 (61%) patients, with the remainder receiving parenteral sedation. Other effects included tachycardia in 212 (56%), hypertension in 160 (42%) and hyperthermia in 17 (5%) presentations. No antihypertensives were given. One patient was actively cooled. Complications included 21 (30%) presentations with rhabdomyolysis and 41 (13%) presentations with acute kidney injury. There were two seizures, three intracranial bleeds and one myocardial infarction. The majority (317 [84%]) of patients were managed solely within the ED. The median length of stay was 14 h. There were 41 (11%) mental health admissions. Two deaths occurred: one following an out-ofhospital cardiac arrest and the other a subarachnoid haemorrhage. Conclusion: The main toxicity seen with methamphetamines is acute behavioural disturbance, which is managed well with sedation. Complications, apart from rhabdomyolysis and acute kidney injury, are rare. Most patients are managed within the ED and discharged home.

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Evidence-Based Guidelines for the Pharmacological Management of Acute Methamphetamine-Related Disorders and Toxicity

Cited by 23 publications

References 46 publications

Pharmacological Treatment of Methamphetamine/Amphetamine Dependence: A Systematic Review

Pharmacological Treatment of Methamphetamine/Amphetamine Dependence: A Systematic Review

Neurocognitive Dysfunctions and Their Therapeutic Modulation in Patients With Methamphetamine Dependence: A Pilot Study

Methamphetamine presentations to an emergency department: Management and complications

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