Glimmer of Hope As Drug Crisis Sees More Overdoses
“While much attention is focused on the opioid crisis, a methamphetamine crisis has been quietly, but actively, gaining steam—” Nora D. Volkow, M.D., NIDA director and a senior author of the study linked below.
An overdose is an overdose. We realize the ongoing drug crisis in the United States is headlined with numbers of deaths related to opioid overdose, but the public and health care providers are seeing a rise in methamphetamine use, often in conjunction with opioids or adulterated with fentanyl. The studies are in and staggeringly dark as this next paragraph captures. It’s likely to be worse looking back at 2019, 2020 and 2021. The research efforts in treatment are seeing some encouraging signs, which is what we highlight in our second paragraph.
The opioid crisis has been the focus of the nation’s attention on drug addiction, overdose and treatment for the past several years. However, in the background a wave of methamphetamine overdose deaths has been building. In a recent study, researchers at the National Institute of Drug Abuse (NIDA), a branch of the National Institutes of Health, found that the overdose deaths involving methamphetamine abuse has increased more than 5-fold in the period 2011-2018. This increase was observed for both men and women and across ethnic groups, with the highest overall rates found in American Indian/Alaskan Native and White/Non-Hispanic populations. A number of factors likely contribute to the increasing impact of methamphetamine, including (1) relatively low cost of production from readily available chemicals, (2) restrictions on prescription opioids causing a shift toward stimulants like methamphetamine and cocaine, and (3) mixing of fentanyl with methamphetamine, with or without the user’s knowledge. Regardless of the source, the trend is causing great concern in the drug treatment community because, unlike opioid addiction, there is no medication-assisted treatment analogous to methadone or Suboxone for methamphetamine addiction, nor is there a drug analogous to naloxone that can rapidly reverse a methamphetamine overdose. Moreover, the study was restricted to the last 8 years for which complete, nationwide overdose data were available (2011-2018). It is highly likely that the upward trend has accelerated in the past two years due to the COVID pandemic, which has increased the social isolation that drives drug use while also cutting back on support and treatment services available to those struggling with addiction.
While the surging methamphetamine overdose rate is raising alarms, a large team of scientists from some of the nation’s top biomedical research institutions recently reported a significant advance in the treatment of methamphetamine addiction. In contrast to opioid addiction, where patients prescribed methadone, Suboxone or Vivitrol are able to minimize their cravings and manage their disease, there is no “medication-assisted
treatment” available for methamphetamine addiction. However, the researchers found that administering a combination of naltrexone (the main component of Vivitrol) and bupropion, an FDA-approved anti-depressant drug (brand name Wellbutrin, among others), along with counseling and mobile app treatment reminders, led to a 5-fold increase in avoiding methamphetamine use compared to a control group of patients who received
placebo treatments. Previous studies showed that naltrexone and bupropion when used separately were ineffective, so there appears to be a synergistic outcome from using the two drugs in combination. These results offer a glimmer of hope for the increasing number of people struggling with methamphetamine addiction, but it is important to note that the study involved only 403 patients, so larger clinical trials are needed. Moreover, the
group that received the drug combination still only showed a 16.5% success rate after 6 weeks of treatment, meaning more than 80% of the people still relapsed into meth use. This is a significant improvement over the 3.4% success rate for the placebo group, but illustrates that the drug combination and treatment protocol will likely require further optimization to realize the maximum possible benefit. (For comparison, methadone treatment leads to approximately 33% lower opioid use, i.e. double the efficacy of the naltrexone/bupropion treatment.)