Injectable NTX and oral bupropion—a potential new treatment for meth addiction
A Potential New Treatment for Meth Addiction
A combination treatment for meth use disorder shows significant promise.
Posted June 26, 2022 | Reviewed by Gary Drevitch
Overdose deaths involving meth almost tripled between 2015 and 2019 in people 18 to 64.
While there have long been FDA-approved medical treatments for opioid addiction, there are no approved treatments for meth addiction.
New research has produced promising results by combining two different FDA-approved medications—injectable naltrexone and oral bupropion.
After a 30% increase in 2020, deaths from drug overdoses rose another 15% to a record-breaking nearly 108,000 in 2021, according to new data published in May 2022 by the Centers for Disease Control and Prevention.
The increasing prevalence of meth addiction and overdose deaths
Although a majority of overdose deaths continue to be attributed to fentanyl, a synthetic opioid many times stronger than heroin that is often mixed with other drugs, an increasing percentage involve methamphetamine. Deaths involving synthetic opioids — largely fentanyl — rose to 71,000 from 58,000, while those associated with stimulants — primarily meth — increased from 25,000 to 33,000.
A growing share of such deaths appears to be the result of combining these two substances. Because non-pharmaceutical fentanyl is a white powder, it is easily combined with other drugs, including opioids like heroin, and stimulants like meth and cocaine, and can even be stamped into pills for counterfeit anti-anxiety drugs such as Xanax.
Overdose deaths involving meth almost tripled between 2015 and 2019 in people 18 to 64 according to a 2021 study by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health. Published in JAMA Psychiatry, this research suggests that increases in higher-risk patterns of meth use, such as increases in amphetamine-type stimulant use disorder, frequent use, and use of other drugs at the same time, are contributing to the rise in overdose deaths.
Promising medications that can enhance meth treatment and recovery efficacy
While there have long been FDA-approved medical treatments available for opioid addiction, there is no FDA-approved treatment for meth addiction. As a result, there hasn’t even been an established detox protocol for it. This, despite the reality that meth is obviously highly addictive, and the progression of meth addiction is often extremely rapid and deadly. But this may soon change. A 2021 study conducted at multiple sites in the NIDA Clinical Trials Network and published in the New England Journal of Medicine produced promising results by combining two different FDA-approved medications—injectable naltrexone and oral bupropion.
Naltrexone reduces cravings and helps to block euphoric effects and is commonly used in the treatment of alcohol and opioid use disorders. Bupropion is primarily used as an antidepressant and sold under the brand name Wellbutrin; it's also used as a treatment to aid nicotine cessation (Zyban). They were demonstrated to be safe and effective in treating adults with moderate or severe methamphetamine use disorder in a double-blind, placebo-controlled Phase III clinical trial. The findings suggest this combination of medications may be a beneficial adjunct to current approaches to meth addiction treatment, such as cognitive behavioral therapy (CBT) and contingency management (CM). Conducted from 2017 to 2019 at clinics in multiple community treatment programs nationwide, this study enrolled 403 adult volunteers ages 18 to 65 with moderate to severe methamphetamine use disorder. Participants were randomly assigned to treatment or control groups. In each of two six-week stages, participants in the treatment group received an injection of extended-release naltrexone every three weeks and took extended-release bupropion daily. Those in the control group were given matched placebos over the same time periods. Study researchers performed four urine drug screens at the end of each stage of these two stages. Participants were considered to have “responded” to treatment if at least three of four urine screens were negative.
Overall, participants responded at a significantly higher rate in the treatment group: 16.5% compared to only 3.4% of those in the control group when screened during weeks 5 and 6, and 11.4% compared to 1.8% when screened in weeks 11 and 12. Researchers reported that naltrexone/bupropion’s level of benefit as a treatment for methamphetamine use disorder is similar to most medical treatments for mental health disorders, including antidepressants prescribed for depression and naltrexone prescribed for alcohol use disorder.
Moreover, participants in the treatment group reported fewer cravings than those in the control group, as well as greater improvements in their lives as measured by the Treatment Effectiveness Assessment questionnaire.
Importantly, in previous clinical studies, both bupropion and naltrexone showed limited, inconsistent efficacy in treating methamphetamine use disorder when administered alone. However, as this research indicates, in combination, they seem to have identifiable therapeutic effects that have the potential to help improve treatment and recovery outcomes for those afflicted with meth addiction. Copyright 2022 Dan Mager, MSW
Dan Mager, MSW is the author of Some Assembly Required: A Balanced Approach to Recovery from Addiction and Chronic Pain and Roots and Wings: Mindful Parenting in Recovery. Online: Mindfulhealing4life
References  https://www.nytimes.com/2022/05/11/us/politics/overdose-deaths-fentanyl…  B Han, et. al. Trends in methamphetamine use, use disorder, and related overdose deaths among adults in the United States. JAMA Psychiatry. DOI: 10.1001/jamapsychiatry.2021.2588 (2021).  Madhukar H. Trivedi, Robrina Walker, Walter Ling, Adriane dela Cruz, Gaurav Sharma, Thomas Carmody, Udi E. Ghitza, Aimee Wahle, Mora Kim, Kathy Shores-Wilson, Steven Sparenborg, Phillip Coffin, Joy Schmitz, Katharina Wiest, Gavin Bart, Susan C. Sonne, Sidarth Wakhlu, A. John Rush, Edward V. Nunes, Steven Shoptaw. Bupropion and Naltrexone in Methamphetamine Use Disorder. New England Journal of Medicine, 2021; 384 (2): 140 DOI: 10.1056/NEJMoa2020214