News
Update on Methamphetamines
As a new decade begins, methamphetamines are poised to make a comeback.
During this session during ASAM Virtual 2020, “Methamphetamine 2020: An Update,” Richard Rawson, PhD, research professor and professor emeritus at the University of Vermont, University of California, Los Angeles, said some are referring to the re-emergence of methamphetamine and cocaine as the fourth wave of the 21st Century opioid crisis.
“The dramatically increased availability and use of these psychostimulants poses numerous serious public health challenges,” he said. “During the past five years, overdose deaths associated with cocaine and methamphetamine, mixed with fentanyl, have dramatically increased. Demand for effective treatments is currently a top priority.”
Dr. Rawson discussed common clinical challenges in treating individuals with methamphetamine use disorders, which includes powerful cravings, paranoia, hypersexuality, anhedonia, cognitive deficits and poor retention in treatment.
He also covered treatment for methamphetamine use disorder, including topiramate, mirtazapine, bupropion, naltrexone, and amphetamine/methylphenidate. He then reviewed behavioral interventions, which are key to methamphetamine use disorder treatment. These included contingency management, the community reinforcement approach, cognitive behavioral therapy, motivational interviewing and exercise.
Dr. Rawson said many opioid-naïve individuals who purchase what they think is cocaine or methamphetamine are at high risk for overdose death as a result of the fentanyl included in the street supply of the stimulant drugs. Because of the seriousness of this overdose risk, individuals in treatment for methamphetamine use disorder should be given naloxone, in case of overdose to address the fentanyl risk.
“Unlike the treatment of individuals with opioid use disorder, where there are FDA approved medications with excellent effectiveness, for the treatment of individuals with stimulant use disorders there are no effective medications,” he said. “Behavioral treatments, especially contingency management, have been shown to reduce stimulant use and promote recovery.”
Dr. Rawson said he hopes attendees walk away with a new awareness of the return of methamphetamines and how they can best respond. A current priority is to get the federal Medicaid anti-kickback regulations modified such that incentives, contingency management, can be used within a Medicaid treatment environment, he said.
“An awareness of the current lethality of stimulants and information on the major clinical challenges faced in providing treatment to individuals with SUD,” Dr. Rawson said. “Some elements of effective treatment for individuals with SUD and information on how to get more information and treatment methodologies.”