Methylphenidate substitution for methamphetamine addiction and implications for future randomized clinical trials: a unique case series

Abstract

Background: Methamphetamine Use Disorders (MUD) pharmacotherapy research yields contradictory results.Objective: Our objective was to identify treatment outcome features of intravenous users of methamphetamine (IUM) treated by one healthcare provider using stable methylphenidate (MPH) substitution protocols over an extended interval.Method: We retrospectively examined a database of all intravenous MUD cases (24 patients) treated with short acting MPH and psychotherapy between 2007 and 2013 in a single outpatient addiction treatment facility.Results: Mean duration of treatment was 8 months (<1–31 months). Treatment resulted in full abstinence in 10 cases – maintained until the end of the observation period. Patients who stayed in treatment for more than a month and remained abstinent were more likely to be regular pattern users of methamphetamine (MA), female and characterized as having co-occurring psychiatric disorders that responded to treatment. These patients discontinued intravenous MA use and demonstrated stabilization of their health conditions. One adverse effect was reported by one patient who required emergency department treatment for accidental alcohol poisoning.Conclusion: Our clinical series indicated favorable outcomes and low dropout rates in patients with MUD who were treated several months with short acting MPH with individualized dosing. Adverse effects were rare. Keeping patients engaged in treatment in the first four weeks was critical for good clinical outcomes. Our findings indicated the need for the possible application of pre-selective criteria regarding patterns of use prior to initiation of (MPH) agonist pharmacotherapy of MA dependence. Prospective studies are needed to confirm or reject these clinical observations.