Treating amphetamine use disorder with stimulants: an encouraging new approach
A new study has found that it may be possible to use stimulants to treat stimulant use disorder. People with amphetamine-type stimulant use disorder who are treated with prescription psychostimulants such as methylphenidate and dextroamphetamine (commonly used to treat attention deficit hyperactivity disorder (ADHD)) may lower both their craving and stimulant use, especially if such treatments are administered at high doses. This study was led by Dr. Jutras-Aswad, a researcher at the CHUM Research Centre and a professor of psychiatry and addictology at Université de Montréal.
Although amphetamine-type stimulant (ATS) use disorder is a major global health issue, there is no established pharmacotherapy recommendation for its treatment.
“Not only is there no widely approved pharmacological intervention for ATS use disorder,” says senior author Dr. Didier Jutras-Aswad, “but the US Food and Drug Administration – the FDA – has just asked for feedback on its new draft guidance for developing treatments for cocaine, methamphetamine, and prescription stimulant use disorders. Many countries are looking to improve their approach to support people with such disorders. We hope our research can help guide the next wave of research and recommendations in this field.”
The study pooled the results of ten randomised controlled trials (RCTs) with a total of 561 participants, comparing the treatment of amphetamine-type stimulant use disorder with methylphenidate or dextroamphetamine to placebo. The effects of these drugs on reducing amphetamine use and cravings was modest across the ten RCTs, but Jutras-Aswad and his co-authors found that the effects might increase with higher dosage.
Methylphenidate and dextroamphetamine are commonly used to treat ADHD at maximum daily doses of 108 mg and 50 mg for adults. This research suggests that people with long-term high-dose exposure to amphetamines may require psychostimulant doses that are higher than the clinical recommendations for ADHD. Preferred treatments by people with ATS use disorders, optimal doses, and combination with other non-pharmacological interventions would need to be worked out in future studies.
The meta-analysis is published in Addiction.
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For editors:
This paper is available online after the embargo has lifted ( https://onlinelibrary.wiley.com/doi/10.1111/add.16347), or you may request a copy from Jean O’Reilly, Editorial Manager, Addiction, jean@addictionjournal.org.
To speak with senior author Dr. Didier Jutras-Aswad, please contact him via Communications Advisor Andrée-Anne Toussaint at the CHUM Research Centre by email (andree-anne.toussaint.chum@ssss.gouv.qc.ca) or telephone (+1 514 890-8000, ext. 23675).
Full citation for article: Sharafi H, Bakouni H, McAnulty C, Drouin S, Coronado-Montoya S, Bahremand A, Bach P, Ezard N, Le Foll B, Schütz CG, Siefried KJ, Tardelli VS, Ziegler D, and Jutras-Aswad D. Prescription psychostimulants for the treatment of amphetamine-type stimulant use disorder: A systematic review and meta-analysis of randomized placebo-controlled trials. Addiction. 2023. https://doi.org/10.1111/add.16347
Funding: This meta-analysis was supported by the Canadian Institutes of Health Research (CIHR) (grant number REN-181675), Université de Montréal and Centre de recherche du Centre hospitalier de l’Université de Montréal (CRCHUM). The study sponsor had no role in study conceptualization, data acquisition and analysis, interpretation of results, and manuscript drafting and editing.
Declaration of interests: CM has received scholarships from the Institut universitaire sur les dépendances, the Gaulin Foundation, the Centre Hospitalier de l’Université de Montréal Research Centre, and the Université de Montréal. SCM received financial training support from the Vanier Canada Graduate Scholarship. PB is supported by a Health Professional-Investigator Award from Michael Smith Health Research BC, the St. Paul’s Foundation, and the BC Centre on Substance Use. PB has no conflicts of interest to declare. BLF has obtained funding from Pfizer Inc. (GRAND Awards, including salary support) for investigator-initiated projects. BLF has obtained funding from Indivior for a clinical trial sponsored by Indivior. BLF has in-kind donations of cannabis products from Aurora Cannabis Enterprises Inc. and study medication donations from Pfizer Inc. (varenicline for smoking cessation) and Bioprojet Pharma. BLF was also provided a coil for a Transcranial magnetic stimulation (TMS) study from Brainsway. BLF has obtained industry funding from Canopy Growth Corporation (through research grants handled by the Centre for Addiction and Mental Health and the University of Toronto), Bioprojet Pharma, Alcohol Countermeasure Systems (ACS), Alkermes, and Universal Ibogaine. BLF has participated in a session of a National Advisory Board Meeting (Emerging Trends BUP-XR) for Indivior Canada and has been a consultant for Shinogi. BLF is supported by CAMH, Waypoint Centre for Mental Health Care, a clinician-scientist award from the Department of Family and Community Medicine of the University of Toronto, and a Chair in Addiction Psychiatry from the Department of Psychiatry of the University of Toronto. DJA receives study material from Cardiol Therapeutics for a clinical trial funded by the Quebec Ministry of Health and Social Services, and holds a clinical scientist career award from Fonds de Recherche du Québec (FRQS).
Addiction is a monthly international scientific journal publishing peer-reviewed research reports on alcohol, substances, tobacco, gambling, editorials, and other debate pieces. Owned by the Society for the Study of Addiction, it has been in continuous publication since 1884.
JOURNAL
Addiction
METHOD OF RESEARCH
Meta-analysis
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Prescription psychostimulants for the treatment of amphetamine-type stimulant use disorder: A systematic review and meta-analysis of randomized placebo-controlled trials
ARTICLE PUBLICATION DATE
26-Oct-2023
COI STATEMENT
CM has received scholarships from the Institut universitaire sur les dépendances, the Gaulin Foundation, the Centre Hospitalier de l’Université de Montréal Research Centre, and the Université de Montréal. SCM received financial training support from the Vanier Canada Graduate Scholarship. PB is supported by a Health Professional-Investigator Award from Michael Smith Health Research BC, the St. Paul’s Foundation, and the BC Centre on Substance Use. PB has no conflicts of interest to declare. BLF has obtained funding from Pfizer Inc. (GRAND Awards, including salary support) for investigator-initiated projects. BLF has obtained funding from Indivior for a clinical trial sponsored by Indivior. BLF has in-kind donations of cannabis products from Aurora Cannabis Enterprises Inc. and study medication donations from Pfizer Inc. (varenicline for smoking cessation) and Bioprojet Pharma. BLF was also provided a coil for a Transcranial magnetic stimulation (TMS) study from Brainsway. BLF has obtained industry funding from Canopy Growth Corporation (through research grants handled by the Centre for Addiction and Mental Health and the University of Toronto), Bioprojet Pharma, Alcohol Countermeasure Systems (ACS), Alkermes, and Universal Ibogaine. BLF has participated in a session of a National Advisory Board Meeting (Emerging Trends BUP-XR) for Indivior Canada and has been a consultant for Shinogi. BLF is supported by CAMH, Waypoint Centre for Mental Health Care, a clinician-scientist award from the Department of Family and Community Medicine of the University of Toronto, and a Chair in Addiction Psychiatry from the Department of Psychiatry of the University of Toronto. DJA receives study material from Cardiol Therapeutics for a clinical trial funded by the Quebec Ministry of Health and Social Services, and holds a clinical scientist career award from Fonds de Recherche du Québec (FRQS).
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