by Matthew Brensilver, PhD
Methamphetamine and similar amphetamine-type stimulants represent a substantial public health burden worldwide. The United Nations Office on Drugs and Crime estimates that more individuals use amphetamines than heroin or cocaine and in many countries, the prevalence of amphetamine use needing treatment is exceeded only by opioid use. In the United States, almost 5% report ever using methamphetamine with .4% reporting use in the past year. Methamphetamine abuse is associated with multiple health complications, including HIV infection, hepatitis, cardiac effects, family disruptions and prominent psychiatric consequences including psychosis. Societal costs for methamphetamine abuse are high, estimated in 2005 at more than $23 billion in the U.S.
The primary interventions with evidence of effectiveness are behavioral therapies, which reduce methamphetamine use. The UCLA Center for Behavioral and Addiction Medicine (CBAM) has conducted extensive research into different modalities of behavioral treatments for methamphetamine addiction. We have developed therapies tailored to specific populations, including individuals who are at high risk for HIV transmission. Despite successes, the impact of these treatments is modest. Behavioral therapies have only moderate effect sizes in terms of methamphetamine abstinence and require substantial investments to be skillfully implemented. These facts underscore the need for additional strategies, notably medications.
For years, CBAM has been at the forefront of the efforts to develop a medication for methamphetamine addiction. In this program of research, we have partnered with the National Institutes of Health and pharmaceutical companies to develop effective treatments for methamphetamine dependence. Drug addiction is especially difficult to treat as the disease effectively recruits the brain and body to ensure a steady flow of drug intake. The user typically experiences very unpleasant effects when they make an attempt to quit – and some of these unpleasant symptoms can endure for many months. The pleasure that can normally be derived from non-drug sources is substantially diminished and addicted individuals have often eroded much of the support network that might otherwise support sobriety. Consequently, developing effective treatments remains both a challenge and an important priority.
Researchers at CBAM and other universities have assessed medications that work to treat addiction in different ways. Some medicines interfere with the normal way methamphetamine affects the brain, blunting the effect of the drug, thereby reducing the associated pleasure and likelihood of use. Other medicines reduce the withdrawal effects and craving by mimicking the way that methamphetamine affects the brain. Medications that work through each of these mechanisms have been tested in our clinical studies. CBAM and researchers from the National Institute on Drug Abuse have independently identified evidence that bupropion or Wellbutrin, an antidepressant and anti-smoking medication, is effective for moderate methamphetamine addiction. One problem, however, is that people who are addicted to drugs tend not to be good at taking all the doses of their prescribed medication. To investigate this, CBAM researchers recently conducted a study of bupropion for methamphetamine addiction and measured the amount of the bupropion that was in the blood of participants. We then examined if people who were taking the medicine reduced methamphetamine use more than people who were not taking their medicine. Indeed, we found that those who were properly taking their medicine used less methamphetamine, were more likely to be completely off drugs at the end of the study and participated more in treatment. These findings suggest the potential value of bupropion for methamphetamine addiction, but it will be important to find ways of reliably delivering the medication. Some medicines have been formulated as implant devices, thereby removing the need to take the medicine on a daily basis. Increasingly, this may be important in addiction treatment. CBAM continues to work to pursue these and other strategies to help individuals suffering from addiction.
Dr. Brensilver, the author of this blog post, holds a PhD in Social Work from the University of Southern California and completed his postdoctoral fellowship with CBAM, where he continues to contribute to our research. In addition, he teaches about the intersection of mindfulness and psychotherapy at the UCLA Mindful Awareness Research Center. He also teaches at Against the Stream Buddhist Meditation Society.