For the first time, a medication regime has been found effective for some patients with meth addiction in a large, placebo-controlled trial.   “It’s progress and it’s quite significant,” says Dr. Nora Volkow, longtime director of the National Institute on Drug Abuse, which funded the two-year clinical trial involving roughly 400 patients.  The study was published January 14 in The New England Journal of Medicine.

Unlike opioid addiction, for which medication-assisted treatment is the standard of care, no medication has been approved by the Food and Drug Administration for use with meth.  In the research trial, patients in clinics around the U.S. were treated for 12 weeks with a combination of two medications naltrexone – marketed under the brand name Vivitrol and bupropion – marketed as Wellbutrin or placebo. The treatment helped 13.4% of patients with their addiction, compared with 2.5% of the placebo group.

While a success rate of 13% may not sound all that impressive, Volkow noted that other medications used to treat brain disorders, including mental illness and addiction, often have similar response rates in patients. This medication therapy provides another tool for doctors to try with patients.

Patients received injections of extended-release naltrexone and oral doses of bupropion. Naltrexone, which is already used for treating opioid addiction, blocks opioid receptors in the brain and is proven to reduce cravings in some patients. Bupropion is often used to treat depression.

Researchers say it’s not entirely clear why these drugs worked more effectively in tandem.  Volkow says one theory is that naltrexone reduced physiological cravings for meth, while buproprion’s “antidepressant effects” eased the anxiety people experience when they stop using. Unless treated, that emotional distress can trigger a relapse.  The success rate of the naltrexone-buproprion combination may be improved as doctors refine the method and when supported with other treatments, including behavioral therapy.

This clinical trial was successful enough that the National Institute on Drug Addiction’s Volkow says she expects to move forward toward securing FDA approval. Meanwhile, she predicts some clinicians helping people in recovery will begin using the treatment immediately. The trial did not reveal significant side effects.

This new medical treatment arrives when addiction to methamphetamines has come roaring back, fueled by cheap imports from Mexico. “It’s almost like methamphetamines are falling from the sky right now, with the amount that’s coming through the border and on boats and planes,” says Matthew Donahue with the U.S. Drug Enforcement Administration. According to the DEA, seizures of meth on the Southwestern border with Mexico have more than doubled in the last two years, to more than 170,000 pounds.

The human cost has been catastrophic. Researchers say overdose deaths linked to meth increased fourfold over the last decade. In a public health alert issued last month, the Centers for Disease Control and Prevention warned meth fatalities spiked again more than 30% during the pandemic.

 

National Public Radio report