Matthew Brensilver PhD, Postdoctoral Fellow, Keith G. Heinzerling MD, MPH, Clinical Assistant Professor, Steven Shoptaw PhD, Professor and Vice Dean.
Pharmacotherapy of amphetamine-type stimulant dependence: An update
Article first published online: 25 APR 2013
© 2013 Australasian Professional Society on Alcohol and other Drugs
Drug and Alcohol Review
Volume 32, Issue 5, pages 449–460, September 2013
How to Cite
Brensilver, M., Heinzerling, K. G. and Shoptaw, S. (2013), Pharmacotherapy of amphetamine-type stimulant dependence: An update. Drug and Alcohol Review, 32: 449–460. doi: 10.1111/dar.12048
- Issue published online: 15 SEP 2013
- Article first published online: 25 APR 2013
- Manuscript Accepted: 1 APR 2013
- Manuscript Received: 19 OCT 2012
- National Institute on Drug Abuse. Grant Numbers: P50 DA-12755, P50 DA-18185, K23 DA023558, T32 DA026400
Methamphetamine- or amphetamine-type stimulants are the second most frequently used illicit drug worldwide, second only to cannabis. Behavioural treatments are efficacious, but their impact is limited underscoring the need for other treatment options, notably, pharmacotherapy.
A review of randomised controlled trials of pharmacotherapies for methamphetamine- or amphetamine-type stimulants was performed using PubMed and Google Scholar databases. Evidence for efficacy of medications is reported.
Clinical trials have yielded no broadly effective pharmacotherapy. Promising signals have been observed for methylphenidate, naltrexone, bupropion and mirtazapine in subgroups of patients in reducing stimulant use (e.g. patients with less severe dependence at baseline and men who have sex with men), though none has produced an unambiguous, replicable signal of efficacy.
Problems in Phase II trials, including high dropout rates, missing data and a lack of agreement on outcomes, complicate efforts to find a broadly effective pharmacotherapy for amphetamine-type stimulant disorders. Efforts to address these problems include calls for better validation of pharmacological target exposure, receptor binding and functional modulation. As well, there is a need for agreement in using findings from preclinical and early phases of the medication development process for selecting better pharmacotherapy candidates.
After over 20 years of efforts worldwide to develop a broadly effective medication for dependence on methamphetamine- or amphetamine-type stimulants, no candidate has emerged. This highlights the need for new compounds, consistent and stringent research methods, better integration between preclinical and clinical stages of medication development, and improved collaboration between government, industry and researchers. [Brensilver M, Heinzerling KG, Shoptaw S. Pharmacotherapy of amphetamine-type stimulant dependence: An update. Drug Alcohol Rev 2013;32:449–460]