Commentary on Konsteniuset al. (2014): On medication development for stimulant addiction

Abstract

The effort to identify a medication, any medication, to treat the broad group of individuals who become dependent on stimulants (methamphetamine, amphetamine) is one of the most significant tasks facing addiction research. This situation may make it tempting to over-interpret the generally positive findings in the Konstenius et al. report in this issue 1. Indeed, the results from the trial are impressive. Participants assigned to high-dose extended release methylphenidate condition were significantly more likely than participants assigned to placebo to reduce attention deficit hyperactive disorder (ADHD) symptoms and to provide scheduled urine samples that were negative both for amphetamine and for other drug metabolites. Time to relapse was longer for those in the active medication condition, as was retention in treatment. The size of the effects of the differences between the medication and placebo groups for both ADHD and drug use outcomes were apparent, even without checking the P-values. The authors are to be congratulated for this achievement. Nevertheless, it is the rarity of this positive report that underscores its importance. If the medication evaluated were anything other than a stimulant, these findings would energize replication trials and in broad groups of stimulant-dependent individuals not comorbid with ADHD; but that is not the case. A probably lackluster response among funders and scientists will highlight that the significant effort to develop medications for stimulant addiction is driven as much by politics as by data. None.