Two-Drug Combo May Help Fight Meth Addiction

In the first stage, the patients (aged 18-65) were divided into two groups. One of them received the combination therapy, which involved an injection of naltrexone every three weeks with a daily dose of bupropion. The other group received placebo injections and pills.

The urine drug test was done four times at each stage. Those in the placebo group who saw no improvement at week six were transferred to stage two and then randomly reassigned to a new treatment group or to another placebo group.

Success was defined as three out of four clean drug tests.

At weeks 5 and 6, almost 17% of the combination treatment group reached this threshold, compared to 3% of the placebo group. At weeks 11 and 12, those numbers were around 11% versus less than 2%. And the treatment dramatically reduced cravings and improved quality of life, both without serious side effects, the researchers reported.

Not that naltrexone plus bupropion is a sure thing. The team predicts that for every nine patients treated, only one will be successful.

And because naltrexone is not a generic, “this treatment, if approved, may come at some cost,” Volkow said. But “the social costs of methamphetamine addiction are [also] high and rising, ”she added.

In all likelihood, “these drugs will now be used ‘off-label’ by physicians to treat their patients with methamphetamine addiction,” while research continues, Volkow said.

This research is badly needed, warned Linda Richter, vice president of prevention research and analysis for the Partnership to End Addiction in New York City.

“The overall efficiency was positive, but low,” Richter noted. “The duration of the study and the size of the sample were limited, and the question remains whether using the combination drugs in conjunction with behavioral therapies would enhance its effects.”

Nonetheless, if further research is also positive, she said, “the drug combination should be widely available and be covered by public and private insurance.”

The results of the study were published on January 14 in the New England Journal of Medicine.

More information

There is more information on methamphetamine abuse at the US National Institute on Drug Abuse.

SOURCES: Nora D. Volkow, MD, director, US National Institute on Drug Abuse, Bethesda, Md .; Linda Richter, PhD, vice president, prevention research and analysis, Partnership to End Addiction, New York City; New England Journal of Medicine, January 14, 2021

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