Pharmacotherapeutic agents in the treatment of methamphetamine dependence

ABSTRACT

Introduction: Methamphetamine use is a serious public health concern in many countries and is second to cannabis as the most widely abused illicit drug in the world. Effective management for methamphetamine dependence remains elusive and the large majority of methamphetamine users relapse following treatment.

Areas covered: Progression in the understanding of the pharmacological basis of methamphetamine use has provided us with innovative opportunities to develop agents to treat dependence. The current review summarizes relevant literature on the neurobiological and clinical correlates associated with methamphetamine use. We then outline agents that have been explored for potential treatments in preclinical studies, human laboratory phase I and phase II trials over the last ten years.

Expert opinion: No agent has demonstrated a broad and strong effect in achieving MA abstinence in Phase II trials. Agents with novel therapeutic targets appear promising. Advancement in MA treatment, including translation into practice, faces several clinical challenges.

KEYWORDS:

• Methamphetamine
• pharmacotherapy
• treatment
• psychostimulant
• substance use

Article Highlights

• Methamphetamine use is a serious public health concern in many countries.

• No single medication has demonstrated a broad and strong treatment effect in clinical trials.

• One trial demonstrated mirtazapine to be effective increasing rates of MA abstinence (primary outcome measure).

• Post-hoc analyses have shown some efficacy according to baseline MA use such as MPH-SR (heavy users), bupropion (light users) and topiramate (abstinent use at baseline).

• Compounds with novel therapeutic targets (eg anti-inflammatory) and modes of delivery (eg pharmacoimmunotherapy) are promising.

• Progression in the field requires strategies to improve compliance as well as more clinical research into novel strategies for efficacy.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.