Medication-Assisted Treatment (MAT) & Meth: Where Are We Headed

There are currently no forms of MAT for methamphetamine use disorder (MUD). But research is ongoing in this area.

Meth Use & How MAT Could Help

Meth is an extremely addictive and dangerous stimulant drug that can quickly cause drug dependence, making changes to the brain and reward pathways. Regular use quickly leads to compulsive drug use and significant drug cravings and withdrawal symptoms when the drug wears off. 

Meth overdoses are on the rise with overdose fatalities involving meth close to tripling between 2015 and 2019 in those between the ages of 18 and 64 in the United States.[1]

MAT, an acronym for Medication-Assisted Treatment or Medication for Addiction Treatment, is a clinically proven, effective method for treating opioid dependence.[2] Medications are FDA-approved to treat both opioid and alcohol dependence, but currently, there are no approved medications for meth dependence and addiction. 

Several studies have highlighted the potential effectiveness of MAT for meth dependence, however. There are promising options on the horizon.

Current Studies Underway

While there are no FDA-approved medications for the treatment of meth dependence, there have been multiple clinical trials that have been performed to determine the effectiveness of MAT for meth. Several medications have shown promise in treating meth dependence and helping to prevent relapse.

Stimulant Replacements

Some of the early clinical trials involving medications for meth dependence used amphetamine and non-amphetamine stimulant replacement medications, which have similar stimulating properties to meth.

For example, methylphenidate is a common ADHD (attention deficit hyperactivity disorder) medication that has shown some effectiveness in reducing meth use. However, as an amphetamine drug, it still has a high potential for misuse and diversion.[3] Therefore it has not yet been approved by the FDA to treat methamphetamine use disorder as the risks are thought to likely still outweigh the benefits. 

Another option that has been considered is the non-amphetamine stimulant modafinil, which is a medication for treating narcolepsy. Modafinil has been shown to help manage symptoms of methamphetamine withdrawal, but it has not been proven to reduce meth use.

Naltrexone

Naltrexone is a medication used for MAT with alcohol use disorder and opioid use disorder. It works to block receptors in the brain to prevent the rewards/positive effects associated with either drinking alcohol or using opioids.

Studies have shown that naltrexone can also be effective in reducing meth cravings and helping to prevent relapse.[4] Larger clinical trials have been inconclusive, however.

Combination of Bupropion & Naltrexone

The most current research shows that a combination of bupropion, an antidepressant that is also used to help people quit smoking, and the opioid-receptor blocking naltrexone can be successful in treating meth dependence as a MAT medication.[5]

Individuals with moderate to severe methamphetamine use disorder were treated with this combination and screened at 6 and 12 weeks. Those on the medication had fewer positive urine screenings for meth than those who weren’t on it, but the percentages are low overall, and this combination has not yet been FDA approved for this purpose. 

Why Is There No Official MAT for Meth Yet?

This could be due to a variety of reasons, such as these:

• Stigma: Meth use disorder is not as visible of an issue as opioid use disorder. There is still a lot of stigma around helping patients with use disorder to get treatment, and methamphetamine use disorder is no exception.
• Lack of consistent evidence: There has been a lack of consensus on the effectiveness of medications that have been studied for meth addiction. Results from studies are often inconclusive and inconsistent. Medications that are used often have negative side effects as well, such as a potential for misuse and addiction themselves.
• No FDA approval: At this point, there are no medications approved for MAT for meth, and the approval process can be long and drawn out. This limits what many practitioners are able to prescribe and what insurance will cover.

Funding for MAT Research

There are grants, such as one through the National Institute of Drug Abuse (NIDA), that are specifically aimed at funding research and development of MAT for substance use disorders. 

Much of this money will go toward MAT for opioid dependence, however, as this is deemed a public health crisis. It is much more visible and at the forefront than meth addiction and dependence. 

Alternatives to MAT for Those Struggling With Meth Addiction

As of now, behavioral therapies are the mainstay of treatment for MUD. Behavioral therapies have been proven to be effective in helping to manage meth cravings, triggers that can lead to relapse, and mental health issues that can accompany meth addiction. 

Cognitive behavioral therapy (CBT) and contingency management are considered some of the most effective treatment methods for meth use disorder to date.[6] 

Behavioral therapies are best delivered as part of a comprehensive treatment plan that includes individual and group therapy and counseling, support groups, educational programming, and encouragement for healthy non-drug related activities. 

Treatment for meth use disorder is still evolving. While therapy is still the backbone of treatment for MUD, medications are showing some evidence of effectiveness and may be part of standard treatment for MUD in the future.