Advances in Treatments for Methamphetamine Use Disorder

According to the 2019 NSDUH, rates among past year methamphetamine users increased from 0.5 percent (or 1.1 million people) in 2016 to 0.8 percent (or 1.7 million people) in 2019. A CDC report showed that 52.9% of the methamphetamine users met criteria for a methamphetamine use disorder (MUD). These adults also reported high rates of co-occurring substance use, and psychiatric disorders and IV use. From 2013 to 2019, age-adjusted death rate involving synthetic opioids rose 1040%, and psychostimulant (mainly illicit methamphetamine) involved overdose rising by 317% to second place, compounding the raging opioid epidemic. Correspondingly, treatment admissions for MUD have risen, but there are few effective treatments, and no FDA approved medications, to date. In this focus session, the three presenters will provide research updates on treatments for MUD focusing on pharmacotherapy; brain stimulation, including transcranial stimulation (TMS); and ketamine. Each of these presenters will also provide a draft outline for respective planned clinical trials to be conducted in NIDA’s National Drug Abuse Treatment Clinical Trials Network (CTN). Madhukar Trivedi, MD will review the pharmacology and emerging pharmacotherapy options for MUD, in addition to presenting the results of a recently completed multi-site, placebo controlled RCT conducted in the CTN, the Pharmacotherapy Treatment for Methamphetamine Use Disorder (or ADAPT-2) study, in which the combination of injectable naltrexone and oral bupropion was effective in reducing methamphetamine use. Kathleen Brady, MD will highlight research updates describing the underlying mechanisms of TMS’s therapeutic action on neurocircuitry, brain targets and preliminary efficacy data for the management of MUD. Manish Jha, MD will present cover the neuropsychology and the potential utility of a N-methyl-D-aspartate (NMDA) glutamatergic receptor antagonist ketamine. The session will end with a Chair-moderated panel discussion and audience question and answer segment.