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Treatment of Stimulant Use Disorders: Current Practices and Promising Perspectives

There is a growing concern in many parts of the world for the large-scale use of psychostimulants for non-medical purposes and high incidence of psychostimulant use disorders (PSUD), also known as stimulant abuse, dependence or addiction. The number of individuals that regularly use psychoactive substances such as cocaine, amphetamines, methamphetamines and other psychostimulants is greater than the number of individuals using opioids and opiates. In spite of this high prevalence, individuals with psychostimulant use disorders around the world are provided minimal or non-existent contact with health and social institutions and very poor treatment programs. In many countries, treatment services…

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 Stimulants

Patients intoxicated with stimulants can present with varying degrees of agitation and psychosis. Patients who demonstrate sympathomimetic examination findings, aggression, or are a potential danger to themselves or others, require sedation. First-line treatment for sedation should include liberal amounts of benzodiazepines. Once the patient is no longer intoxicated, motivational interviewing should be used to discuss treatment options; the patient should be given harm reduction resources. While a few medications are being studied for use in patients with SUD, their efficacy is unclear. Contingency management is a demonstrated treatment modality and patients should be referred to agencies that offer it as a treatment option. A large amount of research involves the use of benzodiazepines, specifically midazolam and lorazepam, as a sole agent or in combination in the treatment of severe agitation. Time to sedation is faster for midazolam 5-10 mg IM compared to lorazepam, ranging from 8.5-10 minutes for midazolam to greater than 30 minutes for lorazepam. All single agent regimens were effective in controlling agitation.

 The Best Way to Fight Meth Addiction? Gift Cards

For decades, the most effective treatment for methamphetamine and cocaine addiction has been mostly locked away in small research studies. But with overdose deaths involving meth and cocaine on the rise, policymakers are coming around to the idea of using gift cards to fight drug use.

Articles of Interest

How incentives could better treat stimulant use disorder

Although research has been underway for more than three decades to develop medications for people addicted to cocaine and methamphetamine, to date, none have been approved by the U.S. Food and Drug Administration. However, one group of Penn researchers advocates building on the success of a national program in the VA and efforts in California to increase access to a treatment called contingency management. Contingency management (CM) is a form of behavioral economics developed in the 1990s that focuses on incentivizing behavior for patients, such as receiving a prize or a cash reward, when they prove through biological testing that they have not used stimulants. The concept is as simple as it appears to be powerful.

In a first, FDA tackles treatments for stimulant use disorder

While stimulant use disorder is increasing, there are currently no FDA-approved medications. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), “between 2008 and 2015, amphetamine-related hospitalizations more than tripled, increasing from 55,447 instances to 206,180. SAMSHA published an “evidence-based resource guide” on substance use disorder treatment in June 2020. The document outlined potential interventions such as motivational interviewing, contingency management, community reinforcement approach and cognitive behavioral therapy.

Management of Stimulant Use Disorder

Contingency management (CM) has demonstrated the best effectiveness in the treatment of StUDs compared to any other intervention studied and represents the current standard of care. CM can be combined with other psychosocial interventions and behavioral therapies, such as community reinforcement approach (CRA) and cognitive behavioral therapy (CBT).Pharmacotherapies, including psychostimulant medications, may be utilized offlabel to treat StUD.

Pharmacotherapy treatment of stimulant use disorder

Stimulant use disorder (SUD) is a public health problem in the United States that is associated with increased morbidity and mortality. Psychosocial interventions, such as cognitive behavioral therapy and contingency management, are the main treatment modality for SUDs and no pharmacotherapy is currently FDA approved for this indication. Although some medications show promising data for the treatment of SUD, the evidence remains inconsistent, and the clinical application is limited due to the heterogenicity of the population and the lack of studies in patients with various comorbidities.

Stimulant Use Disorder

As there are no medications currently approved for treating stimulant intoxication or overdose, these symptoms are primarily managed with supportive therapy, which may include providing hydration and food or a safe place to rest.

Substance Use-related Emergency Department Visits and Resource Utilization

Substance use is associated with multiple adverse health outcomes, including increased rates of infectious disease, mental health disorders, and mortality. These outcomes are rapidly increasing over time, with recent data showing that the age-standardized mortality rate due to substance use disorders (SUD) increased by 618.3% between 1980–2014 in the United States. The most common causes of death associated with substance use were injuries and poisoning, along with other external causes.