Treating Methamphetamine Abuse Disorder: As Prevalence of Methamphetamine Abuse Mushrooms, Practitioners Face the Challenge of Treating the Disorder, Its Withdrawal Symptoms, and Stimulant-Induced Psychosis (2014)

Methamphetamine and other amphetamine-type stimulants are the world's second most widely used group of illicit substances (after Cannabis), with prevalence of abuse varying by region and by locales within nations. As prescription use of stimulants has grown dramatically in recent years, so has abuse of these substances. Given the widespread and growing misuse of amphetamine-type stimulants (Box,1-3 page 38), clinicians are faced with the need to learn how to recognize and manage methamphetamine abuse. Both prescribed and non-prescribed uses of stimulants present complex challenges; in this article, we examine effects, manifestations, and current evidence-based behavioral and medical treatments of methamphetamine misuse and abuse, and look ahead to investigational therapies that hold promise for improving the limited existing approaches to management. Effects and manifestations of methamphetamine use Different routes of administration produce different consequences, in terms of medical comorbidity and propensity to induce addiction. Smoked or injected, methamphetamine enters the brain in seconds; snorted or taken by mouth, the drug produces its effects in several minutes and a half hour, respectively. Rapid uptake and effects of methamphetamine result from its ability to cross the blood--brain barrier. Its primary effects are caused by inhibition of dopamine storage and release of intracellular dopamine. Methamphetamine stimulates the CNS and the cardiovascular sys- tern through release of dopamine and norepinephrine, which increases blood pressure, body temperature, and heart rate, and, occasionally, induces arrhythmia that can contribute to heart attack and stroke. Users experience euphoria, hypervigilance, suppressed appetite, and increased libido. Clinical Point In severe cases of intoxication, a benzodiazepine, an antipsychotic, or both, might be indicated beyond calming reassurance [ILLUSTRATION OMITTED] Binge use is common to sustain euphoria and other reinforcing effects, which subside with rapidly developing tolerance. After days of repeated dosing, elevated methamphetamine blood levels can lead to mood disturbances, repetitive motor activities, and psychotic symptoms such as hallucinations, delusions, and paranoia. Acute psychosis can bring on violence and other injurious behaviors that involve law enforcement and emergency medical services. When methamphetamine is used over months or years, health consequences include anorexia, tremor, so-called meth mouth (broken teeth, infections, cavities, burns), insomnia, panic attacks, confusion, depression, irritability, and impaired memory and other cognitive processes. Treating methamphetamine intoxication and withdrawal At initial clinical contact with a person who abuses methamphetamine, practitio- ners may face several acute consequences requiring attention. Prominent among presenting conditions, especially during acute intoxication, are agitation, anxiety, and psychotic symptoms, which may improve by providing the patient with calming reassurance in a quiet space. In more severe cases, a benzodiazepine, antipsychotic, or both might be indicated (4), (5)(Table 1, page 40). Methamphetamine withdrawal is characterized by anxiety, depression, and insomnia. These symptoms generally resolve in a matter of days after the start of withdrawal without pharmacotherapy. In some cases, depression or psychosis becomes chronic, as a result of methamphetamine use itself (6) or as an emergent concomitant psychiatric condition. A sedative-hypnotic medication or an anxiolytic can be used as necessary to ameliorate insomnia or anxiety, respectively. Prolonged depression can be treated with an antidepressant. An antipsychotic might be indicated for long-term management of patients who have persistent psychosis. Therapy for methamphetamine abuse Treatment of methamphetamine abuse--with the goal of stopping drug use--is a complicated matter on 2 counts: * No medications are FDA-approved for treating methamphetamine addiction. …