Can Prescribed Psychostimulants Help Treat Stimulant Use Disorder?

What you need to know

• Prescription psychostimulants may offer benefits for treating stimulant use disorder, particularly for cocaine use disorder.
• Evidence is growing for the use of prescription psychostimulants in treating methamphetamine use disorder as well.
• The potential benefits of prescription psychostimulants should be weighed against the risks of continued use of unregulated stimulants.
• More research and real-world implementation studies are needed to develop protocols and best practices for using prescription psychostimulants to treat stimulant use disorder.

Understanding stimulant use disorder and current treatment approaches

Stimulant use disorder is a complex condition that involves the problematic use of stimulant drugs like cocaine and methamphetamine. These substances can have severe impacts on a person’s health, relationships, and overall quality of life. Traditional treatment approaches have often focused on abstinence-based models and psychosocial interventions. However, there has been growing interest in exploring medication-assisted treatments for stimulant use disorder, similar to how medications like methadone and buprenorphine are used to treat opioid use disorder.

One approach that has gained attention is the use of prescription psychostimulants to treat stimulant use disorder. This may seem counterintuitive at first – using stimulant medications to treat stimulant addiction. However, the rationale is that providing a regulated, controlled dose of a similar substance may help reduce cravings and use of more dangerous unregulated stimulants.

The evidence for prescription psychostimulants in treating stimulant use disorder

The authors of this paper discuss the current state of evidence for using prescription psychostimulants to treat stimulant use disorder. They reference a meta-analysis by Tardelli and colleagues that found prescription psychostimulants, particularly prescription amphetamines given in robust doses, showed a clinically significant beneficial effect in promoting abstinence for individuals with cocaine use disorder.

For methamphetamine use disorder specifically, the evidence is still emerging. The authors note that at the time of the meta-analysis, there were fewer studies focused on methamphetamine use disorder. However, more recent research is accumulating. For example, a nationwide study in Sweden found that lisdexamfetamine (a prescription stimulant) was associated with decreased risk of hospital admission and death for people with amphetamine use disorder.

It’s important to note that the level of evidence for prescription psychostimulants in treating stimulant use disorder is not yet as robust as the evidence for medications used to treat opioid use disorder. However, the authors argue that this should not necessarily prevent implementation efforts, as even well-established treatments like opioid agonist therapy still face barriers to access.

Potential benefits beyond abstinence

While complete abstinence from stimulants is often seen as the primary goal of treatment, the authors emphasize that prescription psychostimulants may offer a range of positive effects even if a person doesn’t achieve full abstinence. These potential benefits include:

1. Reductions in cocaine or methamphetamine use
2. Improvements in overall health
3. Reductions in morbidity (illness) and mortality (death)

The authors suggest that evaluations of prescription psychostimulant treatments should consider a broader range of outcomes beyond just abstinence, taking into account the individual goals of patients.

Weighing the risks and benefits

One of the key points made by the authors is the need to balance the potential risks of prescription psychostimulants against the known harms of continued use of unregulated stimulants. Unregulated cocaine and methamphetamine carry significant risks, including cardiovascular problems and overdose.

While prescription psychostimulants are not without risks, the authors note that previous reviews have not found significant differences between prescription psychostimulants and placebos in terms of serious adverse events or cardiovascular events.

The risk of psychosis is a particular concern with methamphetamine use. The authors acknowledge that prescription psychostimulants may not protect against psychosis, but argue that for patients already experiencing harm from unregulated methamphetamine use, the potential benefits of prescription psychostimulants should still be considered.

The need for implementation studies and protocols

The authors agree with other researchers who have called for more implementation studies to develop protocols for providing prescription psychostimulants in real-world settings. These studies could help answer important questions about:

1. The appropriate duration of treatment with prescription psychostimulants
2. How to monitor and evaluate outcomes
3. Which patients are most likely to benefit from this approach

By implementing prescription psychostimulant treatments in controlled settings and carefully studying the outcomes, researchers and clinicians can gather valuable data to inform best practices and improve care for people with stimulant use disorder.

Addressing broader social and health inequities

The authors acknowledge the importance of addressing broader issues that affect people with stimulant use disorder, such as access to psychiatric support, medical care, housing, and psychosocial treatments. However, they note that these systemic issues require long-term solutions and policy changes.

In the meantime, they argue that healthcare providers have an opportunity to make immediate impacts on patients’ lives by providing interventions like prescription psychostimulants. This is especially important in the context of widening inequities, where people with stimulant use disorder are often among the most vulnerable and underserved populations.

Conclusions

• Prescription psychostimulants show promise as a treatment option for stimulant use disorder, particularly for cocaine use disorder, with emerging evidence for methamphetamine use disorder as well.
• The potential benefits of prescription psychostimulants extend beyond just promoting abstinence and may include improvements in overall health and reductions in harm.
• Careful consideration of the risks and benefits is necessary, weighing the potential side effects of prescription psychostimulants against the known harms of continued use of unregulated stimulants.
• More research and real-world implementation studies are needed to develop evidence-based protocols and best practices for using prescription psychostimulants in the treatment of stimulant use disorder.

As research in this area continues to evolve, it’s important for healthcare providers, policymakers, and individuals affected by stimulant use disorder to stay informed about the potential benefits and limitations of prescription psychostimulant treatments. This approach may offer a valuable addition to the range of tools available for addressing the complex challenges of stimulant use disorder.