MONTREAL – Researchers may finally be on the path to treatment to help people with methamphetamine use disorder.
A modest but encouraging percentage of participants in a study conducted under the aegis of the United States National Institutes of Health responded positively to the combination of two drugs, naltrexone and bupropion.
This is a “very relevant” study, said Doctor Didier Jutras-Aswad, who heads the CHUM’s psychiatry department.
“Particularly in this case, methamphetamine use disorder, we are talking about a type of addiction for which the treatment options are more limited,” said Dr. Jutras-Aswad.
“We have non-pharmacological treatments that do not involve medication and for which the success rates are generally quite low, and we are talking about an addiction for which there is currently no recognized treatment and commonly used in clinical. This study responds to a clinical need that is obvious to me. ”
Bupropion is a well-known antidepressant that is sometimes used to help quit smoking. Naltrexone is used to treat drug addiction, including opioid use disorder and alcohol use disorder.
These two medications, taken in isolation, have not been well studied for methamphetamine use disorder, Jutrad-Aswad said, and they had been studied in combination in smaller studies.
“Here we are doing a much larger study, with enough patients to be able to draw a little more solid conclusions”, he noted.
Reduce or stop
The researchers recruited 403 adults between the ages of 18 and 65 with moderate to severe methamphetamine use disorder. All participants wanted to reduce or stop their use, and they were randomly assigned to the treatment or control group.
Subjects in the treatment group were injected with long-acting naltrexone every three weeks and daily long-acting bupropion tablets. Subjects in the control group received a placebo.
The participants underwent four urine tests after each phase of the study. The researchers considered that they had responded favorably if three of the four analyzes were negative.
In analyzes performed at weeks five and six, 16.5% of participants in the treatment group met this criterion, compared with 3.4% in the control group. In analyzes for weeks 11 and 12, these rates were 11.4% and 1.8%, respectively.
Such data are “encouraging”, believes Dr Jutras-Aswad, but “it is certainly not a panacea”.
“We are talking about 11% or 13% or 16% success,” he said. So for the very, very large majority of people, it is not a therapeutic success. This underscores how difficult this type of addiction is to treat and how much research efforts must be stepped up (…) to have better response rates. ”
Even when an addict decides to stop his amphetamine use, if he succeeds for a few weeks, the recovery rates are very high, he added, which the group’s “starving” response rates. witness illustrate very well.
The data from this study will need to be replicated elsewhere before it can be considered as a standard practice. Still, this still represents a glimmer of hope in an area where good news and progress are scarce.
“This type of addiction, we can say that it is a cemetery of good ideas which have not been translated into convincing data, solid data of effectiveness in clinical studies”, concluded Dr. Jutras-Aswad. .
“So having a study like that is clearly encouraging. For a rare time in our recent scientific history, we have a clinical study with positive results compared to the placebo. “
The findings of this study are published by the prestigious New England Journal of Medicine.
–
