Posts Tagged ‘methamphetmines’

The Heartbreak of Methamphetamine

Reference at the end of this blog

Like so many places in the U.S., my area has struggled not only with heroin/fentanyl use, but also with methamphetamine use. We’ve seen a sharp increase in the numbers of patients at the opioid treatment program who also used methamphetamine.

However, sometimes prospective patients show up for admission to our opioid treatment program who have no opioid use at al. They have great expectations that the medication we use to treat opioid use disorder will also help them stop using methamphetamines. They say that if they could take a drug of some kind to “take the edge off” they would no longer crave and use methamphetamine.

Some of these patients have dabbled with opioids, using them with an assortment of drugs, but they have never become physically dependent and aren’t using opioids regularly when they come for help at our opioid treatment program.

I meet with these patients and talk to them myself, to make sure I get an accurate history of their drug use. But then I must tell them that they are not appropriate for admission to our program. I hasten to tell them that they certainly do need treatment, and we can direct them to the most appropriate provider. But these people are terribly disappointed and often vent a great deal of anger towards me.

Of course, thus far there are no medications approved by the FDA to treat methamphetamine use. Many medications have been studied, and some have shown some promise, only to fail to show benefit in later studies. Neither buprenorphine nor methadone have benefit for methamphetamine use disorder.

I tell these people that if I were to start them on buprenorphine or methadone, they would then develop a physical dependence on that medication, adding to their problems rather than helping. They don’t care. They often say things like we really helped their uncle, who used to use drugs and now is doing well, and why can’t we make an exception because they are so desperate for help?

It’s sad because I’d love to be able to help everyone. The other options in our community don’t look attractive to these people. They include a short-term detox unit and outpatient group and individual counseling. Inpatient detox followed by rehabilitation is available for people with substance disorders at a state-funded program several hours from us.

Behavioral therapies are still the most heavily evidence-based treatment for stimulant use disorder. Contingency management is the most effective intervention that we have (see my blog of June 6, 2021). Other techniques include groups that use the Matrix Model, and individual therapies such as cognitive behavior therapy, motivation enhancement, and 12-step facilitation.

There are no FDA-approved medications that treat stimulant use disorder.

We have long lists of medications that were tried and failed to provide benefit for stimulant use disorders. We also have some tantalizing data about drugs and combinations of drugs that might be proven to work after more study, such as the combination of naltrexone and bupropion. The size of benefit from this combination of medication isn’t great, but anything that can help would be a bonus for desperate patients. Transcranial magnetic stimulation is another intriguing technique that is still undergoing study.

As usual with difficult-to-treat illnesses and desperate patients, many sham treatments have been peddled over the years. Anyone remember Prometa (also known as Gabasync), the proprietary combination of flumazenil, gabapentin, and hydroxyzine? This combination of drugs was peddled as a cure for methamphetamine addiction with a hefty price tag of up to $15,000 per patient. As is so often the case with snake oil vendors, salesmanship outpaced science. Eventually, after proper clinical trials were performed, Prometa was found to be no more effective than placebo. We should expect to see more methamphetamine “cures” peddled as problems with methamphetamine climb.

Of course, patients at the opioid treatment program who are being treated with methadone or buprenorphine also can have or develop stimulant use disorder. Over the past several years, we’ve seen the number of methamphetamine-positive urine drug screens climb.

Our patients’ use patterns vary considerably. Some inject methamphetamine nearly daily. Others smoke or snort it several times a week, and others use in a binge pattern, for several days at a time with long stretches of abstinence between episodes. These patterns of use determine the degree of damage caused to our patients.

Nearly all have some problems caused by methamphetamine. We see financial problems, shattered relationships, decline in physical health, and worsening of mental health problems.

We try to increase patients’ “dose” of counseling, or even refer to inpatient care, but that’s difficult. There’s only one facility in our part of the state that will accept our patients and maintain them on their usual methadone or buprenorphine while treating the methamphetamine use disorder.

Even though the below-referenced article for the National Institute on Drug Abuse was published earlier this year, data from 2020-2021 is expected to be even worse. Stress makes everything worse, and COVID stressors have affected all of us.