April 2021 – A decade ago I traveled on assignment to a Rocky Mountain rehab facility where the rich and famous go to dry out and confront their drug habits. It offered every imaginable therapy to its well-heeled clientele and claimed strong results. But I will never forget what the director of operations told me about the clinic’s biggest failure: “Our results with meth addicts are dismal,” he admitted. But this tragic picture at last may be changing. A recent study found that a regimen of two medications helped some users stay off the drug. 

The medication study used two substances that target withdrawal. Bupropion, an antidepressant also prescribed for smoking cessation, raises dopamine levels in the brain and thus may buffer the misery of steep drops that occur when people stop using meth. Naltrexone, the second medication, is an opioid blocker that “has an effect on the reward circuit, potentially relieving cravings,” explains the study’s lead author, Madhukar H. Trivedi, a psychiatrist at the University of Texas Southwestern Medical Center. In a trial with 403 heavy users of meth, a regimen of the two medications helped 13.6 percent stay off the drug, testing meth-free at least three quarters of the time over a six-week period. Only 2.5 percent of those given placebos achieved that level of abstinence.In addition, a psychosocial intervention called contingency management (CM) has been shown to be especially effective and, while not widely available, is now the first-line therapy for people seeking treatment for meth or cocaine addiction within the U.S. Department of Veterans Affairs health system. 

All addictions are tough to beat, but methamphetamine poses a particular challenge. A key way that researchers measure the addictive grip of a substance is to look at how much dopamine (a neurotransmitter associated with pleasure) floods into the brain’s major reward center during use, based on animal studies. “Methamphetamine is the drug that produces the largest release,” says Nora Volkow, director of the National Institute on Drug Abuse. “An animal will go crazy pressing a lever in order to get the drug,” she adds. Another metric involves real-world human experience: When you try a new substance, what is the likelihood of becoming addicted? “In this respect, methamphetamine ranks along with heroin among the top addictive drugs,” Volkow says.

Volkow hopes that meth users will ultimately have a variety of treatments, including some that combine medication with behavioral therapy. That, she says, is how diseases from depression to diabetes are treated. But “we stigmatize addiction,” Volkow says, “and insurance is willing to pay much less than for another condition. There’s a double standard.”



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