Combination of Naltrexone and Bupropion May Help Treat Methamphetamine Use Disorder

The Centers for Disease Control and Prevention recently reported 81,000 overdose deaths in the 12 months ending May 2020. This figure represents the highest number of overdose deaths ever recorded during a 12-month period. The CDC data also showed that overdose deaths involving cocaine and psychostimulants (methamphetamine) increased 26.5% and 34.8%, respectively — meaning the number of overdose deaths involving psychostimulants now outnumber cocaine-related deaths.

Unlike opioid use disorder, which has evidence-based medications with demonstrated mortality benefits, methamphetamine use disorder is harder to treat. While there are patient-centered strategies aimed at engaging patients who use methamphetamines in treatment — which includes cognitive-behavioral therapy and contingency management — there remains a lack of medications aimed at counteracting the effect or reducing the use of methamphetamines.

There may be some hope. A new study in the New England Journal of Medicine demonstrates that 14% of patients who used methamphetamines and were prescribed a combination of naltrexone, which blocks opioid receptors, and bupropion, an antidepressant, had improvement in their substance use as demonstrated by reduction of urine toxicology screens positive for methamphetamines. This is a modest rate but it represents an amount 5 times more than trial participants who received the placebo.

Why this potential methamphetamine addiction treatment is a game-changer

Justin Alves, MSN, RN, ACRN, CARN, CNE a nurse educator at Boston Medical Center’s Office-Based Addiction Treatment (OBAT), weighs in on the findings.

Justin Alves, MSN, RN, ACRN, CARN, CNE

“Treating patients with methamphetamine use disorder has been a focus of mine since 2013. Unfortunately, a lack of evidence-based medications to treat methamphetamine use disorder has made it difficult to engage providers in caring for this population.

This study is a game-changer in that it offers providers a treatment option with some evidence of success.

At first glance, the results may not seem significant, but we need to remember that given the remarkable increase in methamphetamine use, the population-level benefit could be substantial. 

"At first glance, the results may not seem significant, but we need to remember that given the remarkable increase of methamphetamine use, the population-level benefit could be substantial." Click To Tweet

What also strikes me about the study is the high rates of treatment retention among patients with methamphetamine use disorder, demonstrating that these patients do come back and remain engaged in treatment. Also, this study was done with individuals with moderate to severe methamphetamine use disorder, indicating that for those with less severe illness, there could be a more profound impact.

We are seeing so many patients struggling — and with the data showing a greater than 400% increase in overdose deaths involving psychostimulants in Massachusetts over the last two decades — these results have the potential to change provider attitudes about having treatment options to offer patients."