UT Southwestern research has discovered a combination of drugs that demonstrates a significant improvement to the current treatment of methamphetamine addiction. There is currently no effective treatment for meth use disorder.
“This is a big deal. This is clearly a game-changer for methamphetamine use disorder,” says Dr. Madhukar Trivedi, the psychiatry professor and lead researcher. “It will open up two things: One is a treatment option, and two, it opens up hope. Until now, if you ask a physician about medications to treatment use disorder, physicians had to say, ‘We don’t have any evidence that anything works.'”
The COVID-19 pandemic is accelerating drug overdoses in the United States. There were 81,00 drug overdose deaths in the 12 months that ended in May of 2020, the highest total for any 12 months in the country’s history. Much of the increase has been to synthetic opioids like fentanyl, but the meth epidemic is overshadowed by the attention given to opioids and now COVID-19. Between 2011 and 2017, deaths more than quadrupled from 2011 to 2017, and meth-related hospitalizations were up 245 percent between 2008 and 2015. In the West and Midwest, 70% of local law enforcement agencies say meth is a more significant threat than any other drugs.
“This is a much more difficult disease to treat and has not had any treatment success in the past,” Trivedi says. “A lot of people have done studies but not figured out a way to find treatments that work.”
The study combined naltrexone, an injectable drug used to treat alcohol and opioid addictions, and bupropion, a common antidepressant to treat meth addiction. Of the 403 patients treated, 13.6 percent experienced positive results. Only 2.5 percent of the placebo groups experienced positive results, and given the fact that there is no known treatment for meth use disorder, the results are impactful.
“The people who have studied methamphetamine were trying to use a single agent,” Trivedi says. “I was convinced that this, being a serious illness like other chronic medical illnesses, may require much more aggressive treatment and that we shouldn’t be doing this treatment alone.”
The FDA already approves both drugs, so physicians can start using the formula to treat meth use disorder right away. The idea first came to Trivedi six years ago. He has been developing the medication schedule, consisting of a dose of naltrexone every three weeks and a daily dose of the antidepressant. The study defined a “positive” result as a negative urine test for meth three out of four weeks. Minimum side effects included tremors, malaise, increased sweating, and decreased appetite.
With no regulatory hurdles, physicians’ only step is to put this treatment to general use. “In practice, if the physician for the patient decides they want to prescribe this, medications that are approved by the FDA can be used off label all the time,” Trivedi says. “Time will lead to more practice and real-world data to enhance its use.”
In 2018, almost 1.9 million Americans reported using methamphetamines, according to a report from the Centers for Disease Control and Prevention (CDC). It also said that 10,000 people died in 2017 from overdoses of psychostimulants like methamphetamine. In a 2018 survey from Monitoring the Future, about one in 200 8th, 10th, and 12th graders used methamphetamine in the past year.
“This changes the paradigm for meth use disorder for which treatment is badly needed,” Trivedi says.