Prescription psychostimulants for the treatment of stimulant use disorder: a systematic review and meta-analysis

Tardelli, Vítor S.; Bisaga, Adam; Arcadepani, Felipe B.; Gerra, Gilberto; Levin, Frances R.; Fidalgo, Thiago M.

doi:10.1007/s00213-020-05563-3

Cited by 91 publications

(115 citation statements)

References 107 publications

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“…When the class transition was made to an illicit stimulant, cocaine, it was snorted, and in 12/2/3 (52%) of those interviewed, this occurred after previous prescription stimulants had been tampered with and/or snorted. Of 16.7% of those with lifetime cocaine use and 11.2% of those with lifetime amphetamine use go on to develop stimulant use disorders (80), and it is possible that the present data capture the initial stages of those trajectories.…”

Section: Class Transitionsmentioning

confidence: 96%

Characterizing Pathways of Non-oral Prescription Stimulant Non-medical Use Among Adults Recruited From Reddit

et al. 2021

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Objective: Prescription stimulant non-medical use (NMU) is a national predicament. While the risks of prescription stimulant NMU have been considered, less is known about non-oral use. To focus on this gap, a sample of adults with non-oral prescription stimulant NMU within the last 5-years was recruited. The purpose of the present study was to characterize the pathways and substance transitions associated with prescription stimulant NMU and non-oral prescription stimulant NMU in this unique sample of adults.Methods: Adults (n = 225) reporting non-oral prescription stimulant NMU within the last 5 years were recruited to complete an online survey by banner ads placed on the Reddit website between February and September 2019. After completion of the survey, a second study consisting of an in-depth telephone interview was conducted with 23 participants: interviews took place between July and September 2019. Data reported here include substance, route of administration and class transitions, as well as qualitative data from the interviews.Results: Approximately 1 in 5 began their substance use trajectory with prescription stimulants (19.1%). Other than marijuana, most exposures to illicit substances occurred after both initial prescription stimulant NMU and initial non-oral prescription stimulant NMU. The most frequently reported route of administration transition was from oral use to snorting (n = 158, 70.2%), however, other route of administration transitions included oral use to injection drug use (n = 14, 6%). In-depth interviews elaborated upon these transitions and indicated that prescription stimulant NMU was consequential to substance use pathways.Conclusions: Oral prescription stimulant NMU was a precursor to non-oral prescription stimulant NMU. Non-oral prescription stimulant NMU was a precursor to illicit substance use, suggesting that prescription stimulant NMU impacts substance use pathways and revealing opportunities for intervention.

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Section: Class Transitionsmentioning

confidence: 96%

Characterizing Pathways of Non-oral Prescription Stimulant Non-medical Use Among Adults Recruited From Reddit

et al. 2021

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“…A very recent RCT utilizing injectable naltrexone combined with bupropion for methamphetamine use disorder found a relatively higher response rate for the treatment intervention compared to placebo controls, yet a low overall treatment effect (11.1%) [99]. A few select medications (e.g., n-acetyl-cysteine, methylphenidate, modafinil, dexamphetamine) have shown some 'promise' for psycho-stimulant dependence treatment, or 'maintenance'-type interventions, yet require further rigorous investigation and substantially improved evidence for clearer assessment; while some observers are more optimistic regarding the therapeutic potential or prospects of medications-based treatment for psychostimulants, others do not expect major advances on the horizon of psycho-stimulant treatment in the foreseeable future [100][101][102]. The current standard of care for psycho-stimulant dependence treatment primarily involves on psycho-social interventions; however, their effectiveness is limited and commonly does not produce better outcomes than usual care [47,103,104].…”

Section: Implications For Interventionsmentioning

confidence: 99%

‘Resurgent’, ‘twin’ or ‘silent’ epidemic? A select data overview and observations on increasing psycho-stimulant use and harms in North America

Fischer

O’Keefe-Markman

Lee

et al. 2021

Subst Abuse Treat Prev Policy

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In the early 2000s, increasing prevalence of psycho-stimulant (e.g., crack/cocaine, methamphetamine) use and related harms, including severe adverse health outcomes, was observed among - mostly marginalized - populations of persons using illicit drugs in North America, underscoring an urgent need for interventions options towards improved prevention and treatment. By about 2010, however, the ‘opioid crisis’, featuring unprecedented use and public health burden, had accelerated into full force in North America, largely muting attention to the psycho-stimulant issue until recently. Recent surveillance data on drug use and related mortality/morbidity from the present decade has documented a marked resurgence of psycho-stimulant use and harms especially in at-risk populations, commonly in direct combination with opioids, across North America, resulting in a ‘twin epidemic’ comprised of opioids and psycho-stimulants We briefly review select epidemiological data indicators for these developments from the United States and Canada; in the latter jurisdiction, related evidence has been less prevalent and systematic but corroborating the same trends. Evidently, the (widely ongoing) focus on the ‘opioid epidemic’ as a ‘mono-type’ drug problem has become an anachronism that requires urgent and appropriate correction. We then briefly consider existing, evidence-based options for – prevention and treatment – interventions targeting psycho-stimulant use and harms, which are substantially more limited and/or less efficacious than those available for problematic opioid use, while presenting major gaps and challenges. The observed resurgence of psycho-stimulants may, indirectly, relate to recent efforts towards curtailing (medical) opioid availability, thereby accelerating demand and supply for both illicit opioids and psycho-stimulants. The presently unfolding ‘twin epidemic’ of opioids and psycho-stimulants, combined with limited intervention resources, presents an acute challenge for public health and may crucially undermine actively extensive efforts to reduce opioid-related health harms in North America.

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“…Results were indicative of increased rates of abstinence (RR= 1.45), and prescription amphetamines were efficacious in promoting abstinence (RR = 2.41) [144]. Although the researchers acknowledged that a broad range of factors, including medication dose, ADHD status and concurrent OUD underpins some degree of heterogeneity across trials [144], such sharp contrasts in findings potentially lead to highly divergent paths in both research and clinical development.…”

Section: Many Positive Signals—what Have We Been Missing?mentioning

confidence: 99%

Pharmacotherapeutic strategies for treating cocaine use disorder—what do we have to offer?

et al. 2020

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Background Cocaine use contines to be a significant public health problem world‐wide. However, despite substantial research efforts, no pharmacotherapies are approved for the treatment of cocaine use disorder (CUD). Argument Studies have identified positive signals for a range of medications for treating CUD. These include long‐acting amphetamine formulations, modafinil, topiramate, doxazosin and combined topiramate and mixed amphetamine salts extended‐release (MAS‐ER). However, valid conclusions about a medication's clinical efficacy require nuanced approaches that take into account behavioural phenotypes of the target population (frequency of use, co‐abuse of cocaine and other substances, genetic subgroups, psychiatric comorbidity), variables related to the medication (dose, short‐/long‐acting formulations, titration speed, medication adherence) and other factors that may affect treatment outcomes. Meta‐analyses frequently do not account for these co‐varying factors, which contributes to a somewhat nihilistic view on pharmacotherapeutic options for CUD. In addition, the predominant focus on abstinence, which is difficult for most patients to achieve, may overshadow more nuanced therapeutic signals. Conclusion While there is an emphasis on finding new medications with novel mechanisms of action for treating CUD, currently available medications deserve further investigation based on the existing literature. Evaluating refined metrics of treatment success in well‐defined subgroups of patients, and further exploring combination therapies and their synergy with behavioural/psychosocial interventions, are promising avenues to establishing effective therapies for CUD.

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Prescription psychostimulants for the treatment of stimulant use disorder: a systematic review and meta-analysis

Cited by 91 publications

References 107 publications

Characterizing Pathways of Non-oral Prescription Stimulant Non-medical Use Among Adults Recruited From Reddit

Characterizing Pathways of Non-oral Prescription Stimulant Non-medical Use Among Adults Recruited From Reddit

‘Resurgent’, ‘twin’ or ‘silent’ epidemic? A select data overview and observations on increasing psycho-stimulant use and harms in North America

Pharmacotherapeutic strategies for treating cocaine use disorder—what do we have to offer?

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