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Badrfam R, Zandifar A, Hajialigol A, Rashidian M, Schmidt NB, Morabito D, Qorbani M, Shahrestanaki E, Mehrabani Natanzi M. Efficacy of probiotic supplements in improving the symptoms of psychosis, anxiety, insomnia, and anorexia due to amphetamine and methamphetamine use: a randomized clinical trial. Psychopharmacology (Berl) 2024; 241:1463-1476. [PMID: 38512593 DOI: 10.1007/s00213-024-06577-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/15/2024] [Indexed: 03/23/2024]
Abstract
RATIONALE Changes in the density and diversity of gut microbiota in chronic use of methamphetamine have been mentioned as contributors to psychotic and anxiety symptoms, sleep problems, and loss of appetite. OBJECTIVE In this placebo-controlled clinical trial, we investigated the effect of the probiotic Lactobacillus Acidophilus in improving psychiatric symptoms among hospitalized patients with chronic methamphetamine use along with psychotic symptoms. METHODS 60 inpatients with a history of more than 3 years of methamphetamine use, were randomly assigned to one of two groups receiving either a probiotic capsule or placebo along with risperidone for 8 weeks based on a simple randomization method. In weeks 0, 4, and 8, patients were evaluated using the Brief Psychiatric Rating Scale (BPRS), Beck Anxiety Inventory (BAI), Pittsburgh Sleep Quality Index (PSQI), Simple Appetite Nutritional Questionnaire (SANQ), and Body Mass Index (BMI). RESULTS Compared to the control group, patients receiving probiotics had better sleep quality, greater appetite, and higher body mass index (there were significant interaction effects of group and time at Week 8 in these variables (t = -3.32, B = -1.83, p = .001, d = 0.89), (t = 10.50, B = 2.65, p <.001, d = 1.25) and (t = 3.40, B = 0.76, p <.001, d = 0.30), respectively. In terms of the improvement of psychotic and anxiety symptoms, there was no statistically significant difference between the two groups. CONCLUSIONS The use of probiotics was associated with improved sleep quality, increased appetite, and increased body mass index in patients with chronic methamphetamine use. Conducting more definitive clinical trials with larger sample sizes and longer-term follow-up of cases is recommended.
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Affiliation(s)
- Rahim Badrfam
- Department of Psychiatry, Imam Hossein Hospital, School of Medicine, Alborz University of Medical Sciences, Karaj, Alborz, Iran
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Atefeh Zandifar
- Department of Psychiatry, Imam Hossein Hospital, School of Medicine, Alborz University of Medical Sciences, Karaj, Alborz, Iran.
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran.
| | - Amirhossein Hajialigol
- Alborz Office of Universal Scientific Education and Research Network (USERN), Alborz University of Medical Sciences, Karaj, Iran
| | - Maryam Rashidian
- Alborz Office of Universal Scientific Education and Research Network (USERN), Alborz University of Medical Sciences, Karaj, Iran
| | - Norman Brad Schmidt
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Danielle Morabito
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Ehsan Shahrestanaki
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mahboobeh Mehrabani Natanzi
- Evidence-Based Phytotherapy and Complementary Medicine Research Center, Alborz University of Medical Sciences, Karaj, Iran
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Bahji A, Danilewitz M, Crockford D. Navigating Evidence, Challenges, and Caution in the Treatment of Stimulant Use Disorders. Brain Sci 2023; 13:1416. [PMID: 37891785 PMCID: PMC10605120 DOI: 10.3390/brainsci13101416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/26/2023] [Accepted: 10/01/2023] [Indexed: 10/29/2023] Open
Abstract
Amidst the opioid epidemic, harm reduction-oriented approaches have gained traction, including interventions that focus on prescribing pharmaceutical-grade psychoactive substances, such as opioids, instead of illicit versions, intending to mitigate fatal overdose risks arising from the variability in potency and additives found in illicit drugs. Stimulants have increasingly been found in the victims of opioid overdoses, further prompting some to argue for the prescription of stimulant medications for individuals with stimulant use disorders. Yet, the evidence supporting this practice remains insufficient. In this communication, we critically examine the existing evidence, challenges, and cautions surrounding the treatment of stimulant use disorder.
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Affiliation(s)
- Anees Bahji
- Department of Psychiatry, University of Calgary, Calgary, AB T2R 0N2, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB T2R 0N2, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2R 0N2, Canada
| | - Marlon Danilewitz
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R7, Canada;
- Ontario Shores Center for Mental Health Sciences, Whitby, ON L1N 5S9, Canada
| | - David Crockford
- Department of Psychiatry, University of Calgary, Calgary, AB T2R 0N2, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2R 0N2, Canada
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Amidžić M, Banović Fuentes J, Banović J, Torović L. Notifications and Health Consequences of Unauthorized Pharmaceuticals in Food Supplements. PHARMACY 2023; 11:154. [PMID: 37888499 PMCID: PMC10609884 DOI: 10.3390/pharmacy11050154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/17/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
Health concerns associated with the consumption of food supplements rise in parallel with the rise in the popularity and market availability of these products. In pursuit of data related to the unauthorized presence of pharmaceuticals in food supplements, the Rapid Alert System for Food and Feed (RASFF) database was searched for the 2011-2022 period. The most "popular" pharmaceuticals for the adulteration of food supplements were phosphodiesterase-5 inhibitors (235 records); anorexics and laxatives (76), including sibutramine and its active metabolite N-didesmethyl sibutramine, phenolphthalein and 2,4-dinitrophenol; stimulants, among which 1,3-dimethylamine (97), and synephrine (53) were the most numerous; nootropic drugs (24); anabolics and prohormones (16); and cannabinoid cannabidiol (14) (pending authorization as a novel food ingredient). Over 65% of notifications of interest were classified as serious risks, and over 80% of these were alert or border rejection notifications, mainly generated as a result of official control on the market. The alarming number of RASFF notifications should be considered a public health issue, demanding clear and targeted recommendation for action for the legislature and authorities. A harmonized nutrivigilance system should be considered as a tool to detect and scrutinize the adverse health effects of food supplements, along with measures to improve their safety, quality, and testing.
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Affiliation(s)
- Maja Amidžić
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (M.A.); (J.B.F.)
| | - Jelena Banović Fuentes
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (M.A.); (J.B.F.)
| | - Jovica Banović
- Department of Internal Medicine, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia;
| | - Ljilja Torović
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia; (M.A.); (J.B.F.)
- Center for Medical and Pharmaceutical Investigations and Quality Control, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
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Marinelli S, Basile G, Manfredini R, Zaami S. Sex- and Gender-Specific Drug Abuse Dynamics: The Need for Tailored Therapeutic Approaches. J Pers Med 2023; 13:965. [PMID: 37373954 DOI: 10.3390/jpm13060965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Sex and gender have been gaining ever greater attention due to their associated risks, dynamics, patterns and protective factors underlying substance abuse and addiction. Such differentiations and the clarification of complexities thereof take on even greater relevance in light of drug abuse scope worldwide. According to the 2022 World Drug Report released by the United Nations Office on Drugs and Crime (UNODC), in 2020 an estimated 284 million people worldwide aged 15-64 had used a drug within the last 12 months. The authors have set out to shed a light on determinants and contributing factors of drug abuse based on sex and gender and outline policy and medicolegal remarks aimed at delineating sex- and gender-based approaches towards drug abuse therapeutic interventions that are both therapeutically and ethically/legally viable and grounded in an evidence-based set of standards. Neurobiological data suggest that estrogen may facilitate drug taking by interacting with reward- and stress-related systems. In animal research, the administration of estrogen increases drug taking and facilitates the acquisition, escalation, and reinstatement of cocaine-seeking behavior. From a medicolegal perspective, it is of utmost importance to take into account the whole picture constituting each patient profile, which certainly includes gender factors and contributors, when outlining a therapeutic approach. Failure to do so could lead to negligence-based malpractice allegations, in light of the scientific findings representing best practices with which clinicians need to comply when caring for SUD patients.
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Affiliation(s)
- Susanna Marinelli
- School of Law, Università Politecnica delle Marche, 60121 Ancona, Italy
| | | | - Roberto Manfredini
- University Center for Studies on Gender Medicine, Department of Medical Sciences, University of Ferrara, Via Luigi Borsari 46, 44121 Ferrara, Italy
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, "Sapienza" University of Rome, 00161 Rome, Italy
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Orjiakor CT, Eze J, Chinweoke M, Ezenwa M, Orjiakor I, Onwujekwe O, Palamar J. A systematic review of actors, actions, and outcomes of community-based efforts to prevent or reduce methamphetamine use. ADDICTION RESEARCH & THEORY 2023; 31:335-344. [PMID: 37990720 PMCID: PMC10659144 DOI: 10.1080/16066359.2023.2167982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/09/2023] [Indexed: 11/23/2023]
Abstract
Background There has been an increase in methamphetamine use across the globe, despite widespread control of the drug, prevention, and treatment. Community-based approaches have proven effective in tackling diverse health-related challenges including substance use; however, little is known regarding community programs targeting methamphetamine use. We conducted a systematic literature review on community programs aimed at tackling the use of methamphetamine across the globe. Method Relevant literature from peer-reviewed and gray literature sources were systematically identified. A grid template was used to extract and synthesize findings from retrieved literature regarding themes of actors, actions, and outcomes related to identified programs. Results A total of 19 documents met our inclusion criteria. Some of the dominant actors in efforts to reduce methamphetamine use in communities were local councils, drug enforcement units, influential persons in the community, people who use or had used methamphetamine, business corporations, and already-existing health promoting platforms. Actions taken were typically education/awareness/information campaigns. Drug enforcement agencies appeared to make little gains when acting alone, and appeared to drive dealers and users underground. Many of the efforts made at the community level were alluded to be beneficial; however, it was difficult to quantify the impact of programs. Community-level efforts also tended to cascade to other drugs. Conclusion Community-based actors and actions are diverse and critical to the prevention of methamphetamine use. There is a need to better coordinate and integrate different actors and interventions so that outcomes can be better monitored and evaluated for greater effectiveness in reducing methamphetamine use.
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Affiliation(s)
- Charles T. Orjiakor
- Department of Psychology, University of Nigeria, Nsukka, Nigeria
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu-Campus, Enugu, Nigeria
| | - John Eze
- Department of Psychology, University of Nigeria, Nsukka, Nigeria
| | - Methodius Chinweoke
- Department of Health Administration and Management, University of Nigeria, Enugu-Campus, Enugu, Nigeria
| | - Michael Ezenwa
- Department of Psychology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Ijeoma Orjiakor
- Department of Psychology, University of Nigeria, Nsukka, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu-Campus, Enugu, Nigeria
- Department of Social Work, University of Nigeria, Nsukka, Nigeria
| | - Joseph Palamar
- Department of Population Health, New York University Langone Medical Center, New York, NY, USA
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Cui Z, Bach P, Ti L, Hayashi K, Morgan J, Milloy MJ, Kerr T. Opioid agonist therapy engagement and crystal methamphetamine use: The impact of unregulated opioid use in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 110:103879. [PMID: 36265327 PMCID: PMC9886012 DOI: 10.1016/j.drugpo.2022.103879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/21/2022] [Accepted: 09/30/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Crystal methamphetamine use has substantially increased among people who use opioids in recent years, yet the impact of opioid agonist therapy (OAT) on crystal methamphetamine use remains poorly characterized. Therefore, we sought to examine the relationship between OAT engagement and crystal methamphetamine use and to assess if this relationship differs according to the ongoing use of unregulated opioids. METHODS Data was collected from two harmonized ongoing prospective cohorts of people who use drugs in Vancouver, Canada, between December 2005 and March 2020. We employed multivariable generalized estimating equations to study the relationship between OAT engagement and crystal meth use stratified by ongoing unregulated opioid use. RESULTS Of 1742 participants who reported frequent opioid use at baseline, the median age was 42 years, and 61.3% were male. Multivariable analyses showed that compared to those who had not received OAT for at least one year: in the absence of ongoing unregulated opioid use, individuals who recently discontinued (adjusted Odds Ratio [aOR] = 0.47, 95% CI = 0.27-0.79), newly initiated (aOR = 0.52, 95% CI = 0.31-0.89), or were retained on OAT (aOR = 0.48, 95% CI = 0.31-0.72) reported a lower frequency of crystal methamphetamine use; in the presence of ongoing unregulated opioid use, individuals who newly initiated OAT reported a greater crystal methamphetamine use frequency (aOR = 1.24, 95% CI = 1.02-1.51). CONCLUSIONS We demonstrated a differential relationship between OAT engagement and crystal methamphetamine use that was conditional on the ongoing use of unregulated opioids. Our findings highlight the complexity of OAT implementation and suggest that polysubstance use patterns should be an important consideration for care providers when devising comprehensive treatment strategies and prognosticating treatment effects.
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Affiliation(s)
- Zishan Cui
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia, V6T 1Z3 Canada
| | - Paxton Bach
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia, V6T 1Z3 Canada
| | - Lianping Ti
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia, V6T 1Z3 Canada
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Jeffrey Morgan
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, British Columbia, V6T 1Z3 Canada
| | - M-J Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia, V6T 1Z3 Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, V6Z 2A9, Canada; Department of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, British Columbia, V6T 1Z3 Canada.
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A case report of clozapine-treatment-resistant schizophrenia successfully managed with brexpiprazole combination therapy. Asian J Psychiatr 2022; 72:103121. [PMID: 35427934 DOI: 10.1016/j.ajp.2022.103121] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/07/2022] [Indexed: 11/24/2022]
Abstract
Clozapine-resistant schizophrenia (CRS) occurs in 40%- 70% of clozapine-treated schizophrenic patients. Hereby we describe a 20-year-old CRS subject with comorbid cannabinoid use disorder, successfully treated with clozapine-brexpiprazole combination, subsequently switched to clozapine plus long-acting injectable aripiprazole.
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8
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Tsai TY, Wang TY, Tseng HH, Chen KC, Chiu CJ, Chen PS, Yang YK. Correlation between loneliness, personality traits, and treatment outcomes in patients with methamphetamine use disorder. Sci Rep 2022; 12:8629. [PMID: 35606379 PMCID: PMC9126870 DOI: 10.1038/s41598-022-11901-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/22/2022] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to investigate whether loneliness and personality traits correlate with the treatment outcome of methamphetamine use disorder. In this 1-year longitudinal study, a total 106 participants (98 males, 8 females), with a mean age 36.3 ± 9.6 years were enrolled. We measured UCLA Loneliness Scale and Tridimensional Personality Questionnaire at baseline, while craving level at baseline, week 12, 24, 36, and 48. Urinary methamphetamine tests were given 17 times. For the evaluation of the data, multiple linear regression and generalized linear mixed models were used. The baseline results showed lower levels of the harm avoidance trait and higher levels of loneliness were significantly associated with higher craving levels (p=0.04 and 0.04). Moreover, loneliness was not only positively associated with craving levels (B=0.05, p<0.01) but with urinary methamphetamine positive results (B= 0.08, p=0.03) during one-year treatment. The findings suggested that loneliness was associated with poor methamphetamine treatment outcome (greater craving levels and higher proportion of positive methamphetamine urine tests) and lower harm avoidance traits are associated with higher craving levels.
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Tran MTN, Luong QH, Le Minh G, Dunne MP, Baker P. Psychosocial Interventions for Amphetamine Type Stimulant Use Disorder: An Overview of Systematic Reviews. Front Psychiatry 2021; 12:512076. [PMID: 34220557 PMCID: PMC8245759 DOI: 10.3389/fpsyt.2021.512076] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 05/06/2021] [Indexed: 12/28/2022] Open
Abstract
Introduction: Amphetamine-type stimulants (ATS) use is a global concern due to increased usage and the harm to physical, mental, and social well-being. The objective of this overview of systematic reviews is to summarise trial results of psychosocial interventions and describe their efficacy and safety. Methods: We searched seven bibliographic databases to November 2020 for systematic reviews examining ATS misuse treatment by psychosocial interventions. Given the apparent incompleteness of the included reviews, we undertook a supplemental meta-analysis of all eligible primary studies. Results: We included 11 systematic reviews of moderate to high quality and 39 primary studies which assessed the outcomes of psychosocial interventions on people who use ATS. The key findings include: (1) There were conflicting results about the effectiveness of psychosocial interventions among reviews, which may confuse decision-makers in selecting treatment. (2) In the supplemental meta-analysis, relative to usual care (only counselling or self-help materials), membership of a psychological intervention group was associated with an important reduction in drug usage [risk ratio (RR) 0.80, 95% CI: 0.75 to 0.85]. Patients in psychological interventions used injectables substantially less [odds ratio (OR) 0.35, 95% CI: 0.24 to 0.49]. The risk of unsafe sex in the psychosocial intervention group was lower than in the control group (RR 0.49, 95% CI: 0.34 to 0.71). The combination of therapies reduced 1.51 day using drugs in the preceding 30 days (95% CI: -2.36 to -0.67) compared to cognitive behavioural therapy intervention alone. (3) Compared to usual care, cognitive behavioural therapy was less likely to be retained at follow-up (RR 0.89, 95% CI: 0.82 to 0.97; high-quality evidence). However, the additional of contingency management strategy can make an important improvement upon retention (RR 1.42, 95%CI: 1.25 to 1.62). Authors' Conclusions: Integrated models are more effective than a single-treatment strategy. Comprehensive and sustained psychosocial interventions can help to reduce use of ATS and other drugs, risk behaviours and mental disorders, and significantly improve treatment adherence.
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Affiliation(s)
- Mai Thi Ngoc Tran
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia.,Center for Training and Research on Substance Abuse-HIV, Hanoi Medical University, Hanoi, Vietnam.,Nursing and Midwifery Faculty, Hanoi Medical University, Hanoi, Vietnam
| | - Quang Hung Luong
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Giang Le Minh
- Center for Training and Research on Substance Abuse-HIV, Hanoi Medical University, Hanoi, Vietnam
| | - Michael P Dunne
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia.,Faculty of Law, Australian Centre of Health Law Research, Queensland University of Technology (QUT), Brisbane, QLD, Australia.,Institute for Community Health Research, Hue University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Philip Baker
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, QLD, Australia
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Paulus MP, Stewart JL. Neurobiology, Clinical Presentation, and Treatment of Methamphetamine Use Disorder: A Review. JAMA Psychiatry 2020; 77:959-966. [PMID: 32267484 PMCID: PMC8098650 DOI: 10.1001/jamapsychiatry.2020.0246] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE The prevalence of and mortality associated with methamphetamine use has doubled during the past 10 years. There is evidence suggesting that methamphetamine use disorder could be the next substance use crisis in the United States and possibly worldwide. OBSERVATION The neurobiology of methamphetamine use disorder extends beyond the acute effect of the drug as a monoaminergic modulator and includes intracellular pathways focused on oxidative stress, neurotoxic and excitotoxic effects, and neuroinflammation. Similarly, the clinical picture extends beyond the acute psychostimulatory symptoms to include complex cardiovascular and cerebrovascular signs and symptoms that need to be identified by the clinician. Although there are no pharmacologic treatments for methamphetamine use disorder, cognitive behavioral therapy, behavioral activation, and contingency management show modest effectiveness. CONCLUSIONS AND RELEVANCE There is a need to better understand the complex neurobiology of methamphetamine use disorder and to develop interventions aimed at novel biological targets. Parsing the disorder into different processes (eg, craving or mood-associated alterations) and targeting the neural systems and biological pathways underlying these processes may lead to greater success in identifying disease-modifying interventions. Finally, mental health professionals need to be trained in recognizing early cardiovascular and cerebrovascular warning signs to mitigate the mortality associated with methamphetamine use disorder.
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Affiliation(s)
- Martin P. Paulus
- Scientific Director and President Laureate Institute for Brain Research 6655 S Yale Ave, Tulsa, OK 74136-3326,Department of Community Medicine, University of Tulsa, Tulsa OK 74104
| | - Jennifer L. Stewart
- Scientific Director and President Laureate Institute for Brain Research 6655 S Yale Ave, Tulsa, OK 74136-3326,Department of Community Medicine, University of Tulsa, Tulsa OK 74104
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An epidemic amphetamine problem: commentary on treatment of amphetamine abuse/use disorder. Daru 2020; 28:417-418. [DOI: 10.1007/s40199-019-00313-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 11/03/2019] [Indexed: 10/25/2022] Open
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