Pharmacotherapy of amphetamine‐type stimulant dependence: An update. (25th April 2013)

• Record Type: Journal Article
• Authors: Brensilver, Matthew; Heinzerling, Keith G.; Shoptaw, Steven
• Is Part Of: Drug and alcohol review. Volume 32:Number 5(2013)
• Page Start: 449
• Page End: 460
• Publication Date: 2013-04-25
• Subjects: Substance abuse -- Periodicals; Alcoholism -- Periodicals; Drinking of alcoholic beverages -- Periodicals; 616.86
• DOI: 10.1111/dar.12048
• Languages: English
• ISSNs: 0959-5236

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="dar12048-sec-0001" sec-type="section"> <title>Issues.</title> <p>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.</p> </sec> <sec id="dar12048-sec-0002" sec-type="section"> <title>Approach.</title> <p>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.</p> </sec> <sec id="dar12048-sec-0003" sec-type="section"> <title>Key Findings.</title> <p>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.</p> </sec> <sec id="dar12048-sec-0004" sec-type="section"> <title>Implications.</title> <p>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.</p> </sec> <sec id="dar12048-sec-0005" sec-type="section"> <title>Conclusion.</title> <p>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. <italic>[Brensilver M, Heinzerling KG, Shoptaw S. Pharmacotherapy of amphetamine‐type stimulant dependence: An update.</italic> Drug Alcohol Rev <italic>2013;32:449–460]</italic></p> </sec> </abstract>