Methamphetamine Use Disorder, Slides of Medicine

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Methamphetamine Use Disorder

Nora D. Volkow, M.D.

Director

National Institute on Drug Abuse

March 1, 2021

Concerns with Methamphetamine

• Highly addictive
• Neurotoxic and damaging to

multiple organs in the body

• Intoxication associated with impulsive risky behaviors including

those that increase risk of HIV and HCV

• Can be easily manufactured in small clandestine

laboratories

• NO medications available to help in its treatment

Evolution of Drivers of Overdose Deaths, All Ages

Analgesics Heroin Fentanyl Stimulants

Natural and Semi- synthetic Opioids and Methadone, 14,

Heroin, 14,

Synthetic Opioids other than Methadone (Primarily Fentanyl), 36, Stimulants, 30,

0

5,

10,

15,

20,

25,

30,

35,

40,

70,630 Deaths in 2019

49,860 from Opioids (Prescription and Illicit)

Source: The Multiple Cause of Death data are produced by the Division of Vital Statistics, National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention (CDC), United States Department of Health and Human Services (US DHHS).

U.S. overdose deaths involving methamphetamine*

age-adjusted rates/100k persons

*Psychostimulants With Abuse Potential ICD-10 code (T43.6). This category is dominated by methamphetamine-involved overdose deaths. Source: CDC, National Center for Health Statistics. Multiple Cause of Death 1999-2019 on CDC WONDER Online Database, released in 2020.

Intersection

Between Drug

Crisis and

COVID-

`

31.96%

19.96%

10.06%

Drug Use Increase During COVID

Millennium Health Signals Report™ COVID-19 Special Edition: Significant Changes in Drug Use During the Pandemic Volume 2.1 Published July 2020

12.52%

Treating Methamphetamine Use Disorder

• No FDA approved medications
• Behavioral therapies: Most effective intervention is

contingency management (uses rewards for evidence of

abstinence) combined with a community reinforcement approach (uses a range of recreational, familial, social, and

vocational reinforcers, to make non-drug-using lifestyle more

rewarding than substance use).

• Studies on the effectiveness of CM have provided over $

per year, and up to $2,000/year. Most treatment programs receiving federal funds are allowed $75/patient per year.

De Crescenzo et al., PLoS Medicine 2018; 15(12): e1002715.

Combination Treatment (Bupropion + Naltrexone) For

Methamphetamine Use Disorder

Trivedi MH, et al. Trial of Bupropion and Naltrexone in Methamphetamine Use Disorder. New England Journal of Medicine. January 14, 2021.

RESPONSES

METHAMPHETAMINE-NEGATIVE

URINE SAMPLES

BLOOD STREAM BRAIN

BEFORE Anti-Meth Antibody Treatment AFTER Anti-Meth Antibody Treatment

Methamphetamine Effects in the Brain

Gentry WB et al., Human Vaccines 2009; 5(4): 206-213.

THANK YOU!