Pharmacotherapy for stimulant use disorders in adults
- Kyle Kampman, MD
Kyle Kampman, MD
- Associate Professor of Psychiatry
- Perelman School of Medicine, University of Pennsylvania
Cocaine, methamphetamine, and other stimulant use disorders are significant public health problems. In the United States, for example, there are 1.5 million regular cocaine users and approximately 353,000 regular methamphetamine users . Cocaine and methamphetamine users have significantly elevated rates of medical morbidity and utilization of healthcare resources .
No medications have been shown in randomized trials to be consistently efficacious for stimulant use disorders. Only psychosocial interventions have proven efficacy in reducing stimulant use in patients with stimulant use disorder, but these treatments alone are insufficient for many patients, prompting research into the neurobiology of stimulant use disorder and trials of several augmenting medications.
Pharmacotherapy for stimulant use disorders is discussed here. Our approach to selecting treatment for stimulant use disorder is described separately. The epidemiology, clinical manifestations, course, consequences, assessment, diagnosis of cocaine use disorder and methamphetamine use disorder are described separately. Psychosocial interventions for stimulant use disorders and prescription drug misuse are also described separately. (See "Approach to treatment of stimulant use disorder in adults" and "Cocaine use disorder in adults: Epidemiology, pharmacology, clinical manifestations, medical consequences, and diagnosis" and "Methamphetamine use disorder: Epidemiology, clinical manifestations, course, assessment, and diagnosis" and "Psychosocial interventions for stimulant use disorder in adults" and "Prescription drug misuse: Epidemiology, prevention, identification, and management".)
APPROACH TO TREATMENT
Our approach to selecting treatment for stimulant use disorder, including psychosocial interventions and medication, is described separately. (See "Approach to treatment of stimulant use disorder in adults".)
Most trials of stimulant use disorder have studied patients using cocaine. Cocaine, amphetamine, and methamphetamine have similar mechanisms of action. This suggests that medications that show some evidence of efficacy for cocaine use may also be efficacious for amphetamine and methamphetamine, and vice versa. Clinical trials have begun testing this hypothesis, but few results have been published to date. Differences in stimulants’ mechanisms of action are summarized below:
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- APPROACH TO TREATMENT
- Synthetic cathinones
- Cocaine use disorder
- - Dopamine agonists
- - Modafinil
- - Disulfiram
- - Bupropion
- - GABAergic medications
- - TA-CD vaccine
- - Other
- Methamphetamine use disorder
- - Bupropion
- - Mirtazapine
- SUMMARY AND RECOMMENDATIONS