Download PDF
Pharmacopsychiatry 2017; 50(03): 87-95
DOI: 10.1055/s-0042-123752
Review
© Georg Thieme Verlag KG Stuttgart · New York

Evidence-Based Guidelines for the Pharmacological Management of Acute Methamphetamine-Related Disorders and Toxicity

Norbert Wodarz   *
1   Center of Addiction Medicine, Department of Psychiatry and Psychotherapy at the Bezirksklinikum, University of Regensburg, Regensburg
,
Anne Krampe-Scheidler   *
2   German Agency for Quality in Medicine (ÄZQ), Berlin
,
Michael Christ
3   Department of Emergency Medicine and Internal Intensive Care, Klinikum Nürnberg Nord, Nürnberg
,
Heribert Fleischmann
4   District Hospital Wöllershof, Neustadt/WN
,
Winfried Looser
5   LVR Clinic Düren, Düren
,
Katharina Schoett
6   Deptartment of Addiction Medicine, Ökumen. Heinrichklinikum, Mühlhausen
,
Frank Vilsmeier
7   Psychiatric Hospital, Rickling
,
Lydia Bothe
2   German Agency for Quality in Medicine (ÄZQ), Berlin
,
Corinna Schaefer
2   German Agency for Quality in Medicine (ÄZQ), Berlin
,
Euphrosyne Gouzoulis-Mayfrank
8   Clinic Cologne, Köln
› Author Affiliations
Further Information

Publication History

received  09 May 2016
revised   29 November 2016

accepted 05 December 2016

Publication Date:
15 March 2017 (online)

Also available at
   Permissions and Reprints

Abstract

Consumption of methamphetamine (“crystal”) has spread dramatically over several European countries. The management of methamphetamine-induced acute disorders has become a growing challenge to the health system. Pharmacological treatment strategies for methamphetamine-induced intoxication syndromes, acute withdrawal symptoms, and methamphetamine-induced psychosis are particularly important.

The development of interdisciplinary and evidence- and consensus-based (S3) German Guidelines was based on a systematic literature and guideline search on therapeutic interventions in methamphetamine-related disorders (April, June 2015). Consideration was given to 9 guidelines and 103 publications. Recommendations on pharmacological treatment strategies were drawn up using the nominal group technique.

Overall, only limited evidence is available. Benzodiazepines are first-line medication for methamphetamine-induced intoxication syndromes, particularly when they present with acute agitation and aggressive behavior. There is no evidence-based medication for the treatment of methamphetamine-related withdrawal symptoms and cravings. When treating methamphetamine-induced psychosis, second-generation antipsychotics should be favored, given their more favorable side-effect profile. The indication for continuation of antipsychotic medication must be reviewed regularly. In most cases, the antipsychotic should be tapered off within 6 months.

Key words

(Crystal) methamphetamine - intoxication - withdrawal - methamphetamine-induced psychosis - treatment guidelines

1,4–7,10 for the Working Group of the S3 Guidelines “Methamphetamine-related Disorders”: http://www.aezq.de/aezq/crystal-meth


* These authors contributed equally to this work.


 

  • References

  • 1 Xie Z, Miller GM. A receptor mechanism for methamphetamine action in dopamine transporter regulation in brain. J Pharmacol Exp Ther 2009; 330: 316-325
    CrossrefPubMedSearch in Google Scholar
  • 2 Rothman RB, Baumann MH, Dersch CM. et al. Amphetamine-type central nervous system stimulants release norepinephrine more potently than they release dopamine and serotonin. Synapse 2001; 39: 32-41
    CrossrefPubMedSearch in Google Scholar
  • 3 Schep LJ, Slaughter RJ, Beasley DM. The clinical toxicology of metamfetamine. Clin Toxicol (Phila) 2010; 48: 675-694
    CrossrefPubMedSearch in Google Scholar
  • 4 Oxford Centre for Evidence-Based Medicine (OCEBM), OCEBM Levels of Evidence Working Group. The Oxford 2011 Levels of Evidence; 2011. Available at http://www.cebm.net/wp-content/uploads/2014/06/CEBM-Levels-of-Evidence-2.1.pdf
    PubMed
  • 5 Hart CL, Gunderson EW, Perez A. et al. Acute physiological and behavioral effects of intranasal methamphetamine in humans. Neuropsychopharmacology 2008; 33: 1847-1855
    CrossrefPubMedSearch in Google Scholar
  • 6 McKetin R, Lubman DI, Najman JM. et al. Does methamphetamine use increase violent behaviour? Evidence from a prospective longitudinal study. Addiction 2014; 109: 798-806
    CrossrefPubMedSearch in Google Scholar
  • 7 Guidelines Development Working Party. Jenner J, Spain D. et al. Management of Patients with Psychostimulant Toxicity: Guidelines for Emergency Departments. Canberra: Australian Government Department of Health and Ageing; 2006
    Search in Google Scholar
  • 8 Turning Point Alcohol and Drug Centre. Lee N, Johns L. et al No 14: Methamphetamine dependence and treatment. Fitzroy, Victoria: Turning Point Alcohol and Drug Centre; 2007
    Search in Google Scholar
  • 9 Drug & Alcohol Services South Australia (DASSA). McIver C, McGregor C. et al. Guidelines for the medical management of patients with methamphetamine-induced psychosis. Morphett Vale: DASSA Southern Service; 2006
    Search in Google Scholar
  • 10 Leelahanaj T, Kongsakon R, Netrakom P. A 4-week, double-blind comparison of olanzapine with haloperidol in the treatment of amphetamine psychosis. J Med Assoc Thai 2005; 88: S43-S52
    PubMedSearch in Google Scholar
  • 11 Verachai V, Rukngan W, Chawanakrasaesin K. et al. Treatment of methamphetamine-induced psychosis: a double-blind randomized controlled trial comparing haloperidol and quetiapine. Psychopharmacology (Berl) 2014; 231: 3099-3108
    CrossrefPubMedSearch in Google Scholar
  • 12 Farnia V, Shakeri J, Tatari F. et al. Randomized controlled trial of aripiprazole versus risperidone for the treatment of amphetamine-induced psychosis. Am J Drug Alcohol Abuse 2014; 40: 10-15
    CrossrefPubMedSearch in Google Scholar
  • 13 Wang G, Zhang Y, Zhang S. et al. Aripiprazole and risperidone for treatment of methamphetamine – associated psychosis in Chinese patients. J Subst Abuse Treat 2016; 62: 84-88
    CrossrefPubMedSearch in Google Scholar
  • 14 McGregor C, Srisurapanont M, Jittiwutikarn J. et al. The nature, time course and severity of methamphetamine withdrawal. Addiction 2005; 100: 1320-1329
    CrossrefPubMedSearch in Google Scholar
  • 15 Zorick T, Nestor L, Miotto K. et al. Withdrawal symptoms in abstinent methamphetamine-dependent subjects. Addiction 2010; 105: 1809-1818
    CrossrefPubMedSearch in Google Scholar
  • 16 Galloway GP, Singleton EG. How long does craving predict use of methamphetamine? Assessment of use one to seven weeks after the assessment of craving: craving and ongoing methamphetamine use. Subst Abuse 2009; 1: 63-79
    PubMedSearch in Google Scholar
  • 17 Hartz DT, Frederick-Osborne SL, Galloway GP. Craving predicts use during treatment for methamphetamine dependence: a prospective, repeated-measures, within-subject analysis. Drug Alcohol Depend 2001; 63: 269-276
    CrossrefPubMedSearch in Google Scholar
  • 18 Sauter D, Abderhalden C, Needham I. et al. Lehrbuch psychiatrische Pflege. 3rd edition Bern: Huber; 2011
    Search in Google Scholar
  • 19 Newton TF, Roache JD, De La Garza R. et al. Bupropion reduces methamphetamine-induced subjective effects and cue-induced craving. Neuropsychopharmacology 2006; 31: 1537-1544
    CrossrefPubMedSearch in Google Scholar
  • 20 Brackins T, Brahm NC, Kissack JC. Treatments for methamphetamine abuse: a literature review for the clinician. J Pharm Pract 2011; 24: 541-550
    CrossrefPubMedSearch in Google Scholar
  • 21 Cruickshank CC, Montebello ME, Dyer KR. et al. A placebo-controlled trial of mirtazapine for the management of methamphetamine withdrawal. Drug Alcohol Rev 2008; 27: 326-333
    CrossrefPubMedSearch in Google Scholar
  • 22 Hellem TL, Lundberg KJ, Renshaw PF. A review of treatment options for co-occurring methamphetamine use disorders and depression. J Addict Nurs 2015; 26: 14-23
    CrossrefPubMedSearch in Google Scholar
  • 23 Shoptaw S, Huber A, Peck J. et al. Randomized, placebo-controlled trial of sertraline and contingency management for the treatment of methamphetamine dependence. Drug Alcohol Depend 2006; 85: 12-18
    CrossrefPubMedSearch in Google Scholar
  • 24 Perez-Mana C, Castells X, Torrens M. et al. Efficacy of psychostimulant drugs for amphetamine abuse or dependence. Cochrane Database Syst Rev 2013; 9: CD009695
    PubMedSearch in Google Scholar
  • 25 Pani PP, Trogu E, Vecchi S. et al. Antidepressants for cocaine dependence and problematic cocaine use. Cochrane Database Syst Rev 2011; CD002950
    PubMedSearch in Google Scholar
  • 26 Rajasingham R, Mimiaga MJ, White JM. et al. A systematic review of behavioral and treatment outcome studies among HIV-infected men who have sex with men who abuse crystal methamphetamine. AIDS Patient Care STDS 2012; 26: 36-52
    CrossrefPubMedSearch in Google Scholar
  • 27 Coffin PO, Santos GM, Das M. et al. Aripiprazole for the treatment of methamphetamine dependence: a randomized, double-blind, placebo-controlled trial. Addiction 2013; 108: 751-761
    CrossrefPubMedSearch in Google Scholar
  • 28 Kishi T, Matsuda Y, Iwata N. et al. Antipsychotics for cocaine or psychostimulant dependence: systematic review and meta-analysis of randomized, placebo-controlled trials. J Clin Psychiatry 2013; 74: e1169-e1180
    CrossrefPubMedSearch in Google Scholar
  • 29 Newton TF, Reid MS, De La Garza R. et al. Evaluation of subjective effects of aripiprazole and methamphetamine in methamphetamine-dependent volunteers. Int J Neuropsychopharmacol 2008; 11: 1037-1045
    CrossrefPubMedSearch in Google Scholar
  • 30 Longo M, Wickes W, Smout M. et al. Randomized controlled trial of dexamphetamine maintenance for the treatment of methamphetamine dependence. Addiction 2010; 105: 146-154
    CrossrefPubMedSearch in Google Scholar
  • 31 Galloway GP, Buscemi R, Coyle JR. et al. A randomized, placebo-controlled trial of sustained-release dextroamphetamine for treatment of methamphetamine addiction. Clin Pharmacol Ther 2011; 89: 276-282
    CrossrefPubMedSearch in Google Scholar
  • 32 Lee N, Pennay A, Hester R. et al. A pilot randomised controlled trial of modafinil during acute methamphetamine withdrawal: feasibility, tolerability and clinical outcomes. Drug Alcohol Rev 2013; 32: 88-95
    CrossrefPubMedSearch in Google Scholar
  • 33 Mahoney JJ, Jackson BJ, Kalechstein AD. et al. Acute modafinil exposure reduces daytime sleepiness in abstinent methamphetamine-dependent volunteers. Int J Neuropsychopharmacol 2012; 15: 1241-1249
    CrossrefPubMedSearch in Google Scholar
  • 34 Dean AC, Sevak RJ, Monterosso JR. et al. Acute modafinil effects on attention and inhibitory control in methamphetamine-dependent humans. J Stud Alcohol Drugs 2011; 72: 943-953
    CrossrefPubMedSearch in Google Scholar
  • 35 Ghahremani DG, Tabibnia G, Monterosso J. et al. Effect of modafinil on learning and task-related brain activity in methamphetamine-dependent and healthy individuals. Neuropsychopharmacology 2011; 36: 950-959
    CrossrefPubMedSearch in Google Scholar
  • 36 Hester R, Lee N, Pennay A. et al. The effects of modafinil treatment on neuropsychological and attentional bias performance during 7-day inpatient withdrawal from methamphetamine dependence. Exp Clin Psychopharmacol 2010; 18: 489-497
    CrossrefPubMedSearch in Google Scholar
  • 37 Mousavi SG, Sharbafchi MR, Salehi M. et al. The efficacy of N-acetylcysteine in the treatment of methamphetamine dependence: a double-blind controlled, crossover study. Arch Iran Med 2015; 18: 28-33
    PubMedSearch in Google Scholar
  • 38 Johnson BA, Roache JD, Ait-Daoud N. et al. Effects of isradipine on methamphetamine-induced changes in attentional and perceptual-motor skills of cognition. Psychopharmacology 2005; 178: 296-302
    CrossrefPubMedSearch in Google Scholar
  • 39 Ray LA, Bujarski S, Courtney KE. et al. The Effects of Naltrexone on Subjective Response to Methamphetamine in a Clinical Sample: a Double-Blind, Placebo-Controlled Laboratory Study. Neuropsychopharmacology 2015; 40: 2347-2356
    CrossrefPubMedSearch in Google Scholar
  • 40 Rezaei F, Ghaderi E, Mardani R. et al. Topiramate for the management of methamphetamine dependence: a pilot randomized, double-blind, placebo-controlled trial. Fundam Clin Pharmacol 2016; 30: 282-289
    CrossrefPubMedSearch in Google Scholar
  • 41 Johnson BA, Ait-Daoud N, Elkashef AM. et al. A preliminary randomized, double-blind, placebo-controlled study of the safety and efficacy of ondansetron in the treatment of methamphetamine dependence. Int J Neuropsychopharmacol 2008; 11: 1-14
    PubMedSearch in Google Scholar
  • 42 Urschel 3rd HC, Hanselka LL, Baron M. A controlled trial of flumazenil and gabapentin for initial treatment of methylamphetamine dependence. J Psychopharmacol 2011; 25: 254-262
    CrossrefPubMedSearch in Google Scholar
  • 43 Grant JE, Odlaug BL, Kim SW. A double-blind, placebo-controlled study of N-acetyl cysteine plus naltrexone for methamphetamine dependence. Eur Neuropsychopharmacol 2010; 20: 823-828
    CrossrefPubMedSearch in Google Scholar
  • 44 Kalechstein AD, Mahoney 3rd JJ, Verrico CD. et al. Short-term, low-dose varenicline administration enhances information processing speed in methamphetamine-dependent users. Neuropharmacology 2014; 85: 493-498
    CrossrefPubMedSearch in Google Scholar
  • 45 Verrico CD, Mahoney 3rd JJ, Thompson-Lake DG. et al. Safety and efficacy of varenicline to reduce positive subjective effects produced by methamphetamine in methamphetamine-dependent volunteers. Int J Neuropsychopharmacol 2014; 17: 223-233
    CrossrefPubMedSearch in Google Scholar
  • 46 Kalechstein AD, Yoon JH, Croft DE. et al. Low dose, short-term rivastigmine administration does not affect neurocognition in methamphetamine dependent individuals. Pharmacol Biochem Behav 2011; 99: 423-427
    CrossrefPubMedSearch in Google Scholar
  • 47 De La Garza R, Mahoney 3rd JJ, Culbertson C. et al. The acetylcholinesterase inhibitor rivastigmine does not alter total choices for methamphetamine, but may reduce positive subjective effects, in a laboratory model of intravenous self-administration in human volunteers. Pharmacol Biochem Behav 2008; 89: 200-208
    CrossrefPubMedSearch in Google Scholar
  • 48 LaRowe SD, Kalivas PW, Nicholas JS. et al. A double-blind placebo-controlled trial of N-acetylcysteine in the treatment of cocaine dependence. Am J Addict 2013; 22: 443-452
    CrossrefPubMedSearch in Google Scholar
  • 49 Lin SK. Pharmacological means of reducing human drug dependence: a selective and narrative review of the clinical literature. Br J Clin Pharmacol 2014; 77: 242-252
    CrossrefPubMedSearch in Google Scholar
  • 50 Balter RE, Cooper ZD, Haney M. Novel Pharmacologic Approaches to Treating Cannabis Use Disorder. Curr Addict Rep 2014; 1: 137-143
    CrossrefPubMedSearch in Google Scholar
  • 51 Marshall K, Gowing L, Ali R. et al. Pharmacotherapies for cannabis dependence. Cochrane Database Syst Rev 2014; CD008940
    PubMedSearch in Google Scholar
  • 52 Uys JD, LaLumiere RT. Glutamate: the new frontier in pharmacotherapy for cocaine addiction. CNS Neurol Disord Drug Targets 2008; 7: 482-491
    CrossrefPubMedSearch in Google Scholar