However, it is not well-documented yet if BCBT is superior to pharmacological treatments for amphetamine abuse or a combination of the two treatments can work better. Two studies reviewed examined dexamphetamine as stimulant agonist treatment. The first study reviewed 49 participants with MA dependence and prescribed 110 mg daily sustained-release oral dexamphetamine over 16 weeks. It measured MA use by self-report and analysis of hair, severity of dependence over time and treatment retention—finding no statistically significant difference between the study groups on planned analysis. Post-hoc analysis demonstrated a reduction in MA dependence symptoms in the dexamphetamine arm compared with placebo using the Leeds Dependence Questionnaire 50.
Srisurapanont 1999b published and unpublished data
Nine of the 43 studies (21%) enrolled only males 24, 29, 30, 34, 46, 52, 55, 57, 58, however not all of these were by design. One study 45 did not report the sample by those randomised, only by completers (in a non-intention-to-treat analysis) and so the total randomised figure of men versus women was not able to be determined based on randomisation (authors did not respond to a request for further data). Conducting a traditional systematic review and meta-analyses is predicated on the assumption of studies reporting on similar outcomes, using similar outcome measures, and with similar methodology. However, the data we reviewed herein was disparate in respect to the reported outcomes and measures. This prohibited meta-analysis of the literature but allowed for a comprehensive report on the current status of the research. This result shows that the subjective effects of lisdexamfetamine were not enhanced when the drug was given intravenously.
Risk of bias in included studies
Vital signs and a detailed history are difficult to obtain secondary to agitation, paranoia, and the extent of psychosis. The diagnosis should be considered in any patient with tachycardia, hypertension, and psychosis. If possible, the history should focus on the route of administration, dosage (amount and the number of usages), and time frame. Clinicians should also ask about co-ingestions to help distinguish mixed presentations and symptoms, as most users frequently use sedatives (alcohol, opioids, benzodiazepines, cannabis). At all times, the protection of the patient and the medical staff need to be considered if agitation or psychosis is present. Amphetamines contain a methyl group to the alpha position on its carbon chain resulting in lipophilicity, increasing its volume of distribution, and CNS stimulation.
Pharmacotherapy for amphetamine dependence: A systematic review
Harmonisation of outcomes and outcome measures to produce results that can be synthesised by meta-analyses should be a sector-wide imperative, to ensure better research synthesis. At a minimum, reduction in MA/AMPH use (e.g. days used or reduction in MA/AMPH-positive UDS) is required for assessment of efficacy. The reliance on extended periods of ‘abstinence’ as a primary endpoint does not always reflect participant treatment goals and is a somewhat insensitive marker of clinically meaningful change in substance use. However, further work is required to determine outcomes that are both clinically meaningful and meaningful to consumers. Risk of bias in individual study methods and reporting are included in Supplementary Table 1 and Supplementary Data (see ESM) as considerations across a number of domains.
Short-Term Effects of Amphetamines
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- The statistical methods for dealing with a data set with significant and non significant heterogeneity were described in ‘Data synthesis’.
- There are a few pharmacotherapy candidates for the treatment of AMPH/MA dependence/use disorder that demonstrate some weak positive signals.
- Furthermore, high rates of treatment retention were reported at six-month and 12-month follow-ups 20–23.
- In reality, there is little abuse of these drugs by patients with ADHD (Merkel and Kuchibhatla, 2009), and in most cases the challenge for the prescribing doctor is to keep the patients taking their medication rather than limiting its use.
- Amineptine is an atypical tricyclic antidepressant that selectively inhibits the reuptake of dopamine and norepinephrine.
The final study enrolled 56 Iranian MA-dependent participants for 10 weeks of treatment examining craving as the primary outcome 54. At Week 10 of the Amphetamine Addiction study there was a reduction in craving in the treatment arm, and the treatment arm demonstrated fewer positive UDS and reduced depressive symptoms at Week 10 compared with the placebo arm. The first randomised 79 MA/AMPH-dependent participants for 22 weeks to methylphenidate or placebo, with abstinence (measured by twice-weekly UDS, and defined as the weekly percentage of AMPH/MA-positive results) as the primary outcome 51. In intention-to-treat analysis there were no differences in abstinence or study retention rates (defined by number of doses collected), although the methylphenidate arm achieved higher study retention from Week 6.
Enhancing Healthcare Team Outcomes
Following brief exposure to the treatment, the medication is discontinued regardless of response as there is no evidence to suggest a pharmacotherapy for amphetamine withdrawal would have efficacy for amphetamine abuse or dependence. Both isomers of amphetamine dose-dependently increased the extracellular concentrations of noradrenaline in the prefrontal cortex (PFC) and dopamine in the striatum. When comparing the effects of drugs on the efflux of catecholamines in the PFC it is important to take into account the highly unusual neuroanatomy of this brain region. The density of DAT sites on PFC dopaminergic neurones is very low (Hitri et al., 1991), and as a consequence, most dopamine that is released is sequestered via NET into noradrenergic neurones (Mazei et al., 2002; Morón et al., 2002; Stahl, 2003). The high prevalence (about 87%) of amphetamine withdrawal in amphetamine users (Cantwell 1998, Schuckit 1999) suggests that clinical trials of potential medications for the treatment of amphetamine withdrawal are needed. Additional clinical studies assessing the natural history of amphetamine withdrawal, the role these symptoms play in relapse to amphetamine use, as well as the validity and reliability of clinical measures to assess amphetamine withdrawal, are also needed.
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- In baseline light-MA users or in men, bupropion demonstrated a reduction in MA use 60.
- After the initial rush, there is typically a state of high agitation that in some individuals may lead to violent behavior.
- It remains unknown whether improved outcomes in successfully resolving amphetamine withdrawal would also correspond with longer term abstinence outcomes.
- According to the DSM-5 criteria, a diagnosis of substance use disorder (SUD) requires meeting at least 2 of the specified criteria within a 12-month period.
How Does Amphetamine Abuse Lead to Addiction?
The most effective treatments for amphetamine addiction are cognitive-behavioral intervention and contingency-management models. Contingency management interventions, which provide tangible incentives in exchange for engaging in treatment and maintaining abstinence, have also been shown to be effective. This page provides information on the types of amphetamines and signs of amphetamine addiction, and it explains the ways this drug can be misused. It also describes the effects of amphetamines, including overdose and withdrawal symptoms, and how to get help if you or someone you love is struggling with amphetamine addiction. Stopping consumption after long-term use results also causes amphetamine withdrawal symptoms.
