Journal ArticleDOI
Pharmacotherapy for methamphetamine/amphetamine use disorder-a systematic review and meta-analysis
Brian Chan,Michele Freeman,Karli Kondo,Chelsea Ayers,Jessica Montgomery,Robin Paynter,Devan Kansagara +6 more
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TLDR
On the basis of low to moderate strength evidence, most medications evaluated for methamphetamine/amphetamine use disorder have not shown a statistically significant benefit, however, there is low strength evidence that methylphenidate may reduce use.Abstract:
Aims Addiction to methamphetamine/amphetamine (MA/A) is a major public health problem. Currently there are no pharmacotherapies for MA/A use disorder that have been approved for use by the US Food and Drug Administration or the European Medicines Agency. We reviewed the effectiveness of pharmacotherapy for MA/A use disorder to assess the quality, publication bias and overall strength of the evidence. Methods Systematic review and meta-analysis. We searched multiple data sources (MEDLINE, PsycINFO and Cochrane Library) to April 2019 for systematic reviews (SRs) and randomized controlled trials (RCTs). Included studies recruited adults who had MA/A use disorder; sample sizes ranged from 19 to 229 participants. Outcomes of interest were abstinence, defined as 3 or more consecutive weeks with negative urine drug screens (UDS); overall use, analyzed as the proportion of MA/A negative UDS specimens; and treatment retention. One SR of pharmacotherapies for MA/A use disorder and 17 additional RCTs met our inclusion criteria encompassing 17 different drugs (antidepressants, antipsychotics, psychostimulants, anticonvulsants and opioid antagonists). We combined the findings of trials with comparable interventions and outcome measures in random-effects meta-analyses. We assessed quality, publication bias and the strength of evidence for each outcome using standardized criteria. Results There was low-strength evidence from two RCTs that methylphenidate may reduce MA/A use: 6.5 versus 2.8% MA/A-negative UDS in one study (n = 34, P = 0.008) and 23 versus 16% in another study (n = 54, P = 0.047). Antidepressants as a class had no statistically significant effect on abstinence or retention on the basis of moderate strength evidence. Studies of anticonvulsants, antipsychotics (aripiprazole), opioid antagonists (naltrexone), varenicline and atomoxetine provided either low-strength or insufficient evidence of no effect on the outcomes of interest. Many of the studies had high or unclear risk of bias. Conclusions On the basis of low- to moderate-strength evidence, most medications evaluated for methamphetamine/amphetamine use disorder have not shown a statistically significant benefit. However, there is low-strength evidence that methylphenidate may reduce use.read more
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Journal ArticleDOI
Neurobiology, Clinical Presentation, and Treatment of Methamphetamine Use Disorder: A Review
TL;DR: A need to better understand the complex neurobiology of methamphetamine use disorder and to develop interventions aimed at novel biological targets is needed and mental health professionals need to be trained in recognizing early cardiovascular and cerebrovascular warning signs to mitigate the mortality associated with methamphetamine use Disorder.
Journal ArticleDOI
Bupropion and Naltrexone in Methamphetamine Use Disorder
Madhukar H. Trivedi,Robrina Walker,Walter Ling,Adriane M. dela Cruz,Gaurav Sharma,Thomas Carmody,Udi E. Ghitza,Aimee Wahle,Mora Kim,Kathy Shores-Wilson,Steven Sparenborg,Phillip O. Coffin,Joy M. Schmitz,Katharina Wiest,Gavin Bart,Susan C. Sonne,Sidarth Wakhlu,A. John Rush,A. John Rush,A. John Rush,Edward V. Nunes,Steven Shoptaw +21 more
TL;DR: In this article, the use of naltrexone plus bupropion to treat methamphetamine use disorder has not been well studied and a multisite, double-blind, two-stage, placebo-contr...
Journal ArticleDOI
Treatment of stimulant use disorder: A systematic review of reviews.
Claire Ronsley,Seonaid Nolan,Rod Knight,Kanna Hayashi,Jano Klimas,Alexander Y. Walley,Alexander Y. Walley,Evan Wood,Nadia Fairbairn +8 more
TL;DR: There was sufficient evidence to support the efficacy of contingency management programs for treatment of stimulant use disorder, but psychostimulants, n-acetylcysteine, opioid agonist therapy, disulfiram and antidepressant pharmacological interventions were found to have insufficient evidence tosupport or discount their use.
Journal ArticleDOI
Combined Pharmacotherapy and Cognitive Behavioral Therapy for Adults With Alcohol or Substance Use Disorders: A Systematic Review and Meta-analysis.
Lara A. Ray,Lindsay R. Meredith,Brian D. Kiluk,Justin Walthers,Kathleen M. Carroll,Molly Magill +5 more
TL;DR: This meta-analysis and systemic review assess combined cognitive behavioral therapy and pharmacotherapy for alcohol or other substance use disorders in adults in adults with a history of substance use problems.
Journal ArticleDOI
Non-pharmacological interventions for methamphetamine use disorder: a systematic review.
TL;DR: While CM interventions showed the strongest evidence favouring the outcomes assessed, tailored CBT alone or with CM was also effective in the target population and should be considered as the first line of treatment for methamphetamine use disorder.
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