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.

Key words

(Crystal) methamphetamine - treatment guidelines - rehabilitation - substitution - stimulant - comorbidity - dependence - review - associated psychosis - depression - induced psychosis

^1,3–9,12 for the consensus group of the S3 Guidelines “Methamphetamine-related Disorders”: http://www.crystal-meth.aezq.de

¹ Because only quetiapine has been given marketing authorisation in Germany for relapse prevention in the depressive phases of bipolar disorder, the recommendation could therefore refer only to quetiapine.

• References

• 1 Darke S, Kaye S, McKetin R. et al. Major physical and psychological harms of methamphetamine use. Drug Alcohol Rev 2008; 27: 253-262
• 2 Newton TF, Kalechstein AD, Duran S. et al. Methamphetamine abstinence syndrome: Preliminary findings. Am J Addict 2004; 13: 248-255
• 3 Simon SL, Dean AC, Cordova X. et al. Methamphetamine dependence and neuropsychological functioning: Evaluating change during early abstinence. J Stud Alcohol Drugs 2010; 71: 335-344
• 4 Glasner-Edwards S, Mooney LJ, Marinelli-Casey P. et al. Clinical course and outcomes of methamphetamine-dependent adults with psychosis. J Subst Abuse Treat 2008; 35: 445-450
• 5 Glasner-Edwards S, Marinelli-Casey P, Hillhouse M. et al. Depression among methamphetamine users: Association with outcomes from the Methamphetamine Treatment Project at 3-year follow-up. J Nerv Ment Dis 2009; 197: 225-231
• 6 Oxford Centre for Evidence-Based Medicine (OCEBM), OCEBM levels of evidence working group. The Oxford 2011 levels of evidence. 2011; Available http://www.cebm.net/wp-content/uploads/2014/06/ CEBM-Levels-of-Evidence-2.1.pdf
• 7 Shoptaw S, Huber A, Peck J. et al. Randomized, placebo-controlled trial of sertraline and contingency management for the treatment of methamphetamine dependence. Drug Alcohol Depend 2006; 85: 12-18
• 8 Piasecki MP, Steinagel GM, Thienhaus OJ. et al An exploratory study: the use of paroxetine for methamphetamine craving. J Psychoactive Drugs 2002; 34: 301-304
• 9 Elkashef AM, Rawson RA, Anderson AL. et al. Bupropion for the treatment of methamphetamine dependence. Neuropsychopharmacology 2008; 33: 1162-1170
• 10 Anderson AL, Li SH, Markova D. et al. Bupropion for the treatment of methamphetamine dependence in non-daily users: A randomized, double-blind, placebo-controlled trial. Drug Alcohol Depend 2015; 150: 170-174
• 11 Shoptaw S, Heinzerling KG, Rotheram-Fuller E. et al. Randomized, placebo-controlled trial of bupropion for the treatment of methamphetamine dependence. Drug Alcohol Depend 2008; 96: 222-232
• 12 Heinzerling KG, Swanson AN, Hall TM. et al. Randomized, placebo-controlled trial of bupropion in methamphetamine-dependent participants with less than daily methamphetamine use. Addiction 2014; 109: 1878-1886
• 13 McCann DJ, Li SH. A novel, nonbinary evaluation of success and failure reveals bupropion efficacy versus methamphetamine dependence: Reanalysis of a multisite trial. CNS Neurosci Ther 2012; 18: 414-418
• 14 Brensilver M, Heinzerling KG, Swanson AN. et al. A retrospective analysis of two randomized trials of bupropion for methamphetamine dependence: Suggested guidelines for treatment discontinuation/augmentation. Drug Alcohol Depend 2012; 125: 169-172
• 15 Colfax GN, Santos GM, Das M. et al. Mirtazapine to reduce methamphetamine use: A randomized controlled trial. Arch Gen Psychiatry 2011; 68: 1168-1175
• 16 Galloway GP, Newmeyer J, Knapp T. et al. Imipramine for the treatment of cocaine and methamphetamine dependence. J Addict Dis 1994; 13: 201-216
• 17 Galloway GP, Newmeyer J, Knapp T. et al. A controlled trial of imipramine for the treatment of methamphetamine dependence. J Subst Abuse Treat 1996; 13: 493-497
• 18 Sulaiman AH, Gill JS, Said MA. et al. A randomized, placebo-controlled trial of aripiprazole for the treatment of methamphetamine dependence and associated psychosis. Int J Psychiatry Clin Pract 2012; 17: 131-138
• 19 Coffin PO, Santos GM, Das M. et al. Aripiprazole for the treatment of methamphetamine dependence: A randomized, double-blind, placebo-controlled trial. Addiction 2013; 108: 751-761
• 20 Newton TF, Reid MS, De La Garza R. et al. Evaluation of subjective effects of aripiprazole and methamphetamine in methamphetamine-dependent volunteers. Int J Neuropsychopharmacol 2008; 11: 1037-1045
• 21 Meredith CW, Jaffe C, Cherrier M. et al. Open trial of injectable risperidone for methamphetamine dependence. J Addict Med 2009; 3: 55-65
• 22 Dore G, Sweeting M. Drug-induced psychosis associated with crystalline methamphetamine. Australas Psychiatry 2006; 14: 86-89
• 23 Misra LK, Kofoed L, Oesterheld JR. et al. Olanzapine treatment of methamphetamine psychosis. J Clin Psychopharmacol 2000; 20: 393-394
• 24 Longo M, Wickes W, Smout M. et al. Randomized controlled trial of dexamphetamine maintenance for the treatment of methamphetamine dependence. Addiction 2010; 105: 146-154
• 25 Galloway GP, Buscemi R, Coyle JR. et al. A randomized, placebo-controlled trial of sustained-release dextroamphetamine for treatment of methamphetamine addiction. Clin Pharmacol Ther 2011; 89: 276-282
• 26 Ling W, Chang L, Hillhouse M. et al. Sustained-release methylphenidate in a randomized trial of treatment of methamphetamine use disorder. Addiction 2014; 109: 1489-1500
• 27 Rezaei F, Emami M, Zahed S. et al. Sustained-release methylphenidate in methamphetamine dependence treatment: A double-blind and placebo-controlled trial. Daru 2015; 23: 2
• 28 Anderson AL, Li SH, Biswas K. et al. Modafinil for the treatment of methamphetamine dependence. Drug Alcohol Depend 2012; 120: 135-141
• 29 Heinzerling KG, Swanson AN, Kim S. et al. Randomized, double-blind, placebo-controlled trial of modafinil for the treatment of methamphetamine dependence. Drug Alcohol Depend 2010; 109: 20-29
• 30 Heinzerling KG, Shoptaw S, Peck JA. et al. Randomized, placebo-controlled trial of baclofen and gabapentin for the treatment of methamphetamine dependence. Drug Alcohol Depend 2006; 85: 177-184
• 31 Ray LA, Bujarski S, Courtney KE. et al. The effects of naltrexone on subjective response to methamphetamine in a clinical sample: A double-blind, placebo-controlled laboratory study. Neuropsychopharmacology 2015; 40: 2347-2356
• 32 Mousavi SG, Sharbafchi MR, Salehi M. et al. The efficacy of N-acetylcysteine in the treatment of methamphetamine dependence: A double-blind controlled, crossover study. Arch Iran Med 2015; 18: 28-33
• 33 Johnson BA, Ait-Daoud N, Elkashef AM. et al. A preliminary randomized, double-blind, placebo-controlled study of the safety and efficacy of ondansetron in the treatment of methamphetamine dependence. Int J Neuropsychopharmacol 2008; 11: 1-14
• 34 Elkashef A, Kahn R, Yu E. et al Topiramate for the treatment of methamphetamine addiction: A multi-center placebo-controlled trial. Addiction 2012; 107: 1297-1306
• 35 Ma JZ, Johnson BA, Yu E. et al. Fine-grain analysis of the treatment effect of topiramate on methamphetamine addiction with latent variable analysis. Drug Alcohol Depend 2013; 130: 45-51
• 36 Rezaei F, Ghaderi E, Mardani R et al Topiramate for the management of methamphetamine dependence: A pilot randomized, double-blind, placebo-controlled trial. Fundam Clin Pharmacol. 2016
• 37 Kalechstein AD, Mahoney III JJ, Verrico CD. et al. Short-term, low-dose varenicline administration enhances information processing speed in methamphetamine-dependent users. Neuropharmacology 2014; 85: 493-498
• 38 Verrico CD, Mahoney III JJ, Thompson-Lake DG. et al. Safety and efficacy of varenicline to reduce positive subjective effects produced by methamphetamine in methamphetamine-dependent volunteers. Int J Neuropsychopharmacol 2014; 17: 223-233
• 39 Urschel III HC, Hanselka LL, Baron M. A controlled trial of flumazenil and gabapentin for initial treatment of methylamphetamine dependence. J Psychopharmacol 2011; 25: 254-262
• 40 Ling W, Shoptaw S, Hillhouse M. et al. Double-blind placebo-controlled evaluation of the PROMETA protocol for methamphetamine dependence. Addiction 2012; 107: 361-369
• 41 Grant JE, Odlaug BL, Kim SW. A double-blind, placebo-controlled study of N-acetyl cysteine plus naltrexone for methamphetamine dependence. Eur Neuropsychopharmacol 2010; 20: 823-828
• 42 Milin S, Lotzin A, Degkwitz P et al. Amphetamin und Methamphetamin – Personengruppen mit missbräuchlichem Konsum und Ansatzpunkte für präventive Maßnahmen. Sachbericht 2014 Available http://www.bmg.bund.de/fileadmin/dateien/Publikationen/Drogen_Sucht/Forschungsberichte/ATS-Bericht_final.pdf
• 43 von Mayrhauser C, Brecht ML, Anglin MD. Use ecology and drug use motivations of methamphetamine users admitted to substance abuse treatment facilities in Los Angeles: An emerging profile. J Addict Dis 2002; 21: 45-60
• 44 Wang LJ, Lin SK, Chen YC. et al. Differences in clinical reatures of methamphetamine users with persistent psychosis and patients with schizophrenia. Psychopathology 2016; 49: 108-115
• 45 Volkow ND, Chang L, Wang GJ. et al. Low level of brain dopamine D2 receptors in methamphetamine abusers: Association with metabolism in the orbitofrontal cortex. Am J Psychiatry 2001; 158: 2015-2021
• 46 Bramness JG, Gundersen OH, Guterstam J. et al Amphetamine-induced psychosis–a separate diagnostic entity or primary psychosis triggered in the vulnerable?. BMC Psychiatry 2012; 12: 221
• 47 Verachai V, Rukngan W, Chawanakrasaesin K. et al. Treatment of methamphetamine-induced psychosis: A double-blind randomized controlled trial comparing haloperidol and quetiapine. Psychopharmacology (Berl) 2014; 231: 3099-3108
• 48 Leelahanaj T, Kongsakon R, Netrakom P. A 4-week, double-blind comparison of olanzapine with haloperidol in the treatment of amphetamine psychosis. J Med Assoc Thai 2005; 88: S43-S52
• 49 Farnia V, Shakeri J, Tatari F. et al. Randomized controlled trial of aripiprazole versus risperidone for the treatment of amphetamine-induced psychosis. Am J Drug Alcohol Abuse 2014; 40: 10-15
• 50 Wang G, Zhang Y, Zhang S. et al. Aripiprazole and risperidone for treatment of methamphetamine-associated psychosis in Chinese patients. J Subst Abuse Treat 2016; 62: 84-88
• 51 Sulaiman AH, Gill JS, Said MA. et al. An open-label study of aripiprazole for methamphetamine induced psychosis. [References]. Klinik Psikofarmakoloji Bulteni/Bulletin of Clinical Psychopharmacology 2012; 121-129
• 52 Seddigh R, Keshavarz-Akhlaghi AA, Shariati B. Treating methamphetamine-induced resistant psychosis with clozapine. Case Rep Psychiatry 2014; 2014: 845145
• 53 Deutsche Gesellschaft für Psychiatrie, Psychotherapie und Nervenheilkunde (DGPPN) . Behandlungsleitlinie Schizophrenie. Darmstadt: Steinkopff; 2006
• 54 Zorick T, Sugar CA, Hellemann G. et al. Poor response to sertraline in methamphetamine dependence is associated with sustained craving for methamphetamine. Drug Alcohol Depend 2011; 118: 500-503
• 55 Hellem TL, Lundberg KJ, Renshaw PF. A review of treatment options for co-occurring methamphetamine use disorders and depression. J Addict Nurs 2015; 26: 14-23
• 56 Newton TF, Roache JD, De La Garza R. et al. Bupropion reduces methamphetamine-induced subjective effects and cue-induced craving. Neuropsychopharmacology 2006; 31: 1537-1544
• 57 Cruickshank CC, Montebello ME, Dyer KR. et al. A placebo-controlled trial of mirtazapine for the management of methamphetamine withdrawal. Drug Alcohol Rev 2008; 27: 326-333
• 58 Nejtek VA, Avila M, Chen LA. et al. Do atypical antipsychotics effectively treat co-occurring bipolar disorder and stimulant dependence? A randomized, double-blind trial. J Clin Psychiatry 2008; 69: 1257-1266
• 59 McElhiney MC, Rabkin JG, Rabkin R. et al. Provigil (modafinil) plus cognitive behavioral therapy for methamphetamine use in HIV+ gay men: A pilot study. Am J Drug Alcohol Abuse 2009; 35: 34-37
• 60 Hellem TL, Sung YH, Shi XF. et al. Creatine as a novel treatment for depression in females using methamphetamine: A pilot study. J Dual Diagn 2015; 11: 190-202
• 61 Sung YH, Yurgelun-Todd DA, Shi XF. et al. Decreased frontal lobe phosphocreatine levels in methamphetamine users. [References]. Drug and Alcohol Dependence 2013; 102-109
• 62 Brown ES, Gabrielson B. A randomized, double-blind, placebo-controlled trial of citicoline for bipolar and unipolar depression and methamphetamine dependence. J Affect Disord 2012; 143: 257-260
• 63 Lee N, Pennay A, Hester R. et al. A pilot randomised controlled trial of modafinil during acute methamphetamine withdrawal: Feasibility, tolerability and clinical outcomes. Drug Alcohol Rev 2013; 32: 88-95
• 64 Jovanovski D, Zakzanis KK. Donepezil in a chronic drug user–a potential treatment?. Hum Psychopharmacol 2003; 18: 561-564
• 65 Hester R, Lee N, Pennay A. et al. The effects of modafinil treatment on neuropsychological and attentional bias performance during 7-day inpatient withdrawal from methamphetamine dependence. Exp Clin Psychopharmacol 2010; 18: 489-497
• 66 Dean AC, Sevak RJ, Monterosso JR. et al. Acute modafinil effects on attention and inhibitory control in methamphetamine-dependent humans. J Stud Alcohol Drugs 2011; 72: 943-953
• 67 Kalechstein AD, De La Garza R, Newton TF. Modafinil administration improves working memory in methamphetamine-dependent individuals who demonstrate baseline impairment. Am J Addict 2010; 19: 340-344
• 68 Ghahremani DG, Tabibnia G, Monterosso J. et al. Effect of modafinil on learning and task-related brain activity in methamphetamine-dependent and healthy individuals. Neuropsychopharmacology 2011; 36: 950-959
• 69 Deutsche Gesellschaft für Psychosomatische Medizin und Ärztliche Psychotherapie (DGPM). S3-Leitlinie: Angststörungen. 2014; Available http://www.awmf.org/uploads/tx_szleitlinien/051-028l_S3_Angstst%C3 %B6rungen_2014-05_2.pdf
• 70 Obermeit LC, Cattie JE, Bolden KA. et al Attention-deficit/hyperactivity disorder among chronic methamphetamine users: Frequency, persistence, and adverse effects on everyday functioning. Addict Behav 2013; 38: 2874-2878
• 71 Salo R, Fassbender C, Iosif AM. et al. Predictors of methamphetamine psychosis: History of ADHD-relevant childhood behaviors and drug exposure. Psychiatry Res 2013; 210: 529-535
• 72 Sim T, Simon SL, Domier CP. et al. Cognitive deficits among methamphetamine users with attention deficit hyperactivity disorder symptomatology. J Addict Dis 2002; 21: 75-89
• 73 Ebert D, Krause J, Roth-Sackenheim C. ADHS im Erwachsenenalter – Leitlinien auf Basis eines Expertenkonsensus mit Unterstützung der DGPPN. Nervenarzt 2003; 74: 939-945
• 74 Barkla XM, McArdle PA, Newbury-Birch D. Are there any potentially dangerous pharmacological effects of combining ADHD medication with alcohol and drugs of abuse? A systematic review of the literature. BMC Psychiatry 2015; 15: 270
• 75 Bihlar Muld B, Jokinen J, Bölte S. et al. Long-term outcomes of pharmacologically treated vs. non-treated adults with ADHD and substance use disorder: a naturalistic study. J Subst Abuse Treat 2015; 51: 82-90