Address Methamphetamine Use Research Articles

Addressing methamphetamine use is essential to stopping HIV transmission.

Addressing methamphetamine use is essential to stopping HIV transmission.

Addressing methamphetamine use in opioid use disorder treatment: Clinical perspectives

Addressing methamphetamine use in opioid use disorder treatment: Clinical perspectives

Using ADAPT-ITT framework to tailor evidence-based interventions for addressing methamphetamine use among methadone patients in Vietnam.

Methamphetamine use threatens positive treatment outcomes in substance use and HIV, for people with opioid use disorders (POUD) in many countries. This paper describes the adaptation of four evidence-based interventions (EBI) (motivational interviewing, contingency management, Matrix group model and SMS text messaging) for treating methamphetamine use among POUD receiving methadone maintenance therapy in Vietnam. Following the ADAPT-ITT (Assessment-Decision-Administration-Production-Topical experts-Training-Testing) framework, we conducted 16 focus group discussions with POUD (n = 25) and providers (n = 22) at four methadone clinics in two largest cities (Hanoi in the North, Ho Chi Minh City in the South) to assess patterns of methamphetamine use and to get feedback on proposed EBIs. The proposed EBIs were properly adapted and used to train providers in two of the four methadone clinics. The revised EBIs were tested over 12 weeks among 42 POUD on methadone who use methamphetamine. Post-intervention feedback served to fine-tune the revised EBIs. Insights about patterns of methamphetamine use suggested that EBIs should focus on different triggers to methamphetamine use among POUD receiving methadone treatment in the two cities. All EBIs should emphasise family-related topics to build a strong motivation for treatment. Participants suggested when, where and how each EBI should be delivered. Most participants were satisfied with the adapted EBIs. Limited human resources at methadone clinics might hinder implementation of the adapted EBIs. We successfully completed the adaptation of EBIs for POUD who use methamphetamine on methadone in Vietnam. The pilot testing of the adapted EBIs demonstrated feasibility and acceptability. NCT04706624. Registered 13 January 2021. https://clinicaltrials.gov/ct2/show/NCT04706624.

Development and evaluation of a social marketing campaign to address methamphetamine use in Los Angeles County

BackgroundThis study describes the development and impact of a social marketing campaign in early 2020 intended to prevent and reduce methamphetamine use in Los Angeles County (LAC). We used social marketing principles and the transtheoretical model to design the campaign, which was intended to avoid stigmatization of methamphetamine users and communicate compassion, empathy, and support.MethodsTo evaluate its impact, we collected cross-sectional online survey data post-campaign (n = 1,873) from LAC residents in population segments considered higher risk for methamphetamine use. We examine associations between campaign exposure and outcomes using bivariate analyses and binary logistic regression models, which control for the impact of the COVID-19 pandemic on methamphetamine use or likelihood of use.ResultsThe analyses revealed that campaign exposure was associated with having more negative attitudes toward methamphetamine, calling LAC’s substance abuse service helpline, using methamphetamine fewer days, and considering abstaining. Frequency of exposure to campaign advertisements was positively associated with calling the helpline, suggesting a campaign dose effect. COVID-19-related factors were associated with using methamphetamine in the past 30 days.ConclusionsSocial marketing campaigns hold promise for impacting methamphetamine prevention and cessation behaviors. This study adds to the limited literature on mass marketing interventions to address this major health issue.

Associations between psychosocial risk factors, and changes in substance dependence and psychosocial functioning, during engagement with digital cognitive behavioral therapy for methamphetamine use: use of 'Breaking Free from Substance Abuse' by incarcerated people during the COVID-19 pandemic

BackgroundMethamphetamine use can be associated with involvement with correctional services and incarceration. Traditionally, treatments for methamphetamine use have been delivered in-person – however, lockdowns initiated during the COVID-19 pandemic significantly reduced access to such in-person support in prisons. Therefore, in May 2020 a digital cognitive-behavioral therapy (CBT) program for substance use disorders - 'Breaking Free from Substance Abuse' - was made available across prisons in Ohio in order to meet this treatment gap. This represents the first time this digital CBT intervention has been made widely available to incarcerated people residing in prisons or jails in the United States (US). This was a within-subjects study using data from 2187 Ohio prison residents who engaged with this digital CBT program to address their methamphetamine use.ResultsParticipants reported multiple psychosocial risk factors, including moderate to severe substance dependence, depression and anxiety; interpersonal conflict; aggressive behavior; paranoia; and difficulties with work, education and accommodation. Significant reductions in substance dependence, depression/anxiety and biopsychosocial impairment, and improvements in quality of life, were identified in the sample. Risk factors were associated with less positive outcomes, specifically interpersonal conflict and poor mental health. Completion of specific components of the program were associated with more positive outcomes – a dose response was also identified.ConclusionsDigital CBT can be delivered in secure US correctional settings and may help to fill unmet needs for in-person treatment. Specifically, this digital CBT program may support incarcerated individuals to address methamphetamine use, with outcomes being associated with psychosocial risk factors and program engagement.

Addressing Methamphetamine Use in Primary Care: Provider Perspectives.

The opioid epidemic has evolved into a combined stimulant epidemic, with escalating stimulant and fentanyl-related overdose deaths. Primary care providers are on the frontlines grappling with patients' methamphetamine use. Although effective models exist for treating opioid use disorder in primary care, little is known about current clinical practices for methamphetamine use. Six semistructured group interviews were conducted with 38 primary care providers. Interviews focused on provider perceptions of patients with methamphetamine use problems and their care. Data were analyzed using inductive and thematic analysis and summarized along the following dimensions: (1) problem identification, (2) clinical management, (3) barriers and facilitators to care, and (4) perceived needs to improve services. Primary care providers varied in their approach to identifying and treating patient methamphetamine use. Unlike opioid use disorders, providers reported lacking standardized screening measures and evidence-based treatments, particularly medications, to address methamphetamine use. They seek more standardized screening tools, Food and Drug Administration-approved medications, reliable connections to addiction medicine specialists, and more training. Interest in novel behavioral health interventions suitable for primary care settings was also noteworthy. The findings from this qualitative analysis revealed that primary care providers are using a wide range of tools to screen and treat methamphetamine use, but with little perceived effectiveness. Primary care faces multiple challenges in effectively addressing methamphetamine use among patients singularly or comorbid with opioid use disorders, including the lack of Food and Drug Administration-approved medications, limited patient retention, referral opportunities, funding, and training for methamphetamine use. Focusing on patients' medical issues using a harm reduction, motivational interviewing approach, and linkage with addiction medicine specialists may be the most reasonable options to support primary care in compassionately and effectively managing patients who use methamphetamines.

'Even though you hate everything that's going on, you know they are safer at home': The role of Aboriginal and Torres Strait Islander families in methamphetamine use harm reduction and their own support needs.

IntroductionFirst Nations people who use methamphetamine are overrepresented in regional and remote Australia and more likely to turn to family for support. This can place strain on families. The support needs of family members of individuals using methamphetamine are poorly understood.MethodsWe conducted 19 focus groups and seven interviews with mostly First Nations community, family members and service providers. In total, 147 participants across six sites participated as part of a larger study investigating First Nations perspectives of how to address methamphetamine use and associated harms. We applied a social and emotional wellbeing framework to examine support needs and role of family in mitigating methamphetamine harms.ResultsFindings highlighted the importance of families in providing support to people using methamphetamine and in reducing associated harms, often without external support. The support provided encompassed practical, social, emotional, financial, access to services and maintaining cultural connection. Providing support took a toll on family and negatively impacted their own social and emotional wellbeing.Discussion and ConclusionsFirst Nations families play an important and under‐recognised role in reducing methamphetamine‐related harms and greater efforts are required to support them. Professional resources are needed to deal with impacts of methamphetamine on families; these should be pragmatic, accessible, targeted and culturally appropriate. Support for families and communities should be developed using the social and emotional wellbeing framework that recognises wellbeing and healing as intrinsically connected to holistic health, kinship, community, culture and ancestry, and socioeconomic and historical influences on peoples' lives.

Methamphetamine-associated psychosis: Clinical presentation, biological basis, and treatment options.

Methamphetamine associated psychosis (MAP) represents a mental disorder induced by chronic methamphetamine use in a subset of users. The prevalence of the disorder has increased in several countries in Europe and Asia where methamphetamine use has increased. MAP remains difficult to distinguish from primary psychiatric disorders, especially schizophrenia, creating complications in prescribing treatment plans to patients. This narrative review sought to summarize difficulties related to MAP diagnosis and highlight the need for a better treatment model. Current best practices are described and potential novel therapies and future research suggested. Results suggest that clear biological and clinical differences appear between patients presenting with MAP and schizophrenia and that there may exist distinct subgroups within MAP itself. MAP-specific treatment studies have been few and have focused on the use of antipsychotic medication. Antipsychotic treatment has been shown to alleviate the psychotic symptoms of MAP but produce debilitating adverse effects and fail to adequately address methamphetamine use in patients. Continued identification of subgroups within the heterogenous MAP population may lead to better diagnosis, treatment, and outcomes for patients. Psychosocial therapies should be explored in addressing the cooccurring substance use and psychosis in the treatment of MAP.

Understanding the reasons for using methamphetamine by sexual minority people in Dhaka, Bangladesh

BackgroundInternationally, methamphetamine use is prevalent among males who have sex with males (MSM) and transgender women (hijra), with studies showing its association with risky sexual behaviours leading to HIV transmission. This study aimed to explore the underlying reasons for methamphetamine use among MSM and hijra in Bangladesh. MethodsWe conducted 30 in-depth interviews with MSM and hijra and six focus groups with MSM, hijra and service providers. Data were thematically analysed using manual data analysis procedures. FindingReasons cited for using methamphetamine varied across feminized MSM (i.e. kothis), masculine MSM (i.e. panthis), male sex workers and hijra. For sex workers, increased sexual pleasure and consequent ability to take more clients increased their income. For panthis, methamphetamine enhanced feelings of masculinity and sexual prowess. Kothis were able to feel more feminine due to their ability to receive multiple partners each night. For all participants, methamphetamine restored self-esteem and relieved the stress resulting from stigma. ConclusionsFindings indicate that reasons for using methamphetamine are not only rooted in the individual’s psyche but also grounded in the socio-cultural expectations about masculinities and femininities in Bangladeshi society. Limited knowledge about the complexities concerning methamphetamine use mean that appropriate counselling and treatment services are non-existent in Bangladesh. The study findings can be used to refine national and international harm reduction policies so as to incorporate and address methamphetamine use.

Five-year Changes in Methamphetamine Use, Dependence, and Remission in a Community-recruited Cohort.

Investigate patterns of methamphetamine use over time, specifically factors associated with remission from dependent and harmful patterns of use; and examine drug treatment and health/support service utilization pathways among people who use methamphetamine. People who regularly use methamphetamine were recruited from nontreatment settings in Melbourne, Australia, in 2010, and followed up twice over 5 years. Trajectories of past-month methamphetamine use and methamphetamine dependence were mapped. Random-effects logistic regression modeling identified factors associated with these outcomes. Overall, past-month methamphetamine use and methamphetamine dependence decreased among the cohort over the study period. Variability in methamphetamine use and dependence trajectories was observed; 56% of participants achieved past-month abstinence; however, 14% subsequently relapsed and 44% reported past-month use at every time-point. During the study period, 27% of participants were never classified methamphetamine-dependent, 30% remitted from dependence, and 23% were consistently classified dependent. Factors independently associated with past-month methamphetamine use included male sex and poor physical health. Factors independently associated with methamphetamine dependence included poor physical health, low self-perceived social support, current mental health medication prescription, and current engagement with drug treatment services for methamphetamine use. Engagement with treatment and health/support services remained low (12%-22%) over the study period. Our findings indicate people who remit from methamphetamine dependence, reduce their frequency of use or cease entirely can maintain this over long periods. Initiatives addressing social determinants of health could be optimal for combating methamphetamine dependence. Community-based frontline service providers should be educated in relation to appropriately addressing methamphetamine use.

The state of methamphetamine ('tik') use among youth in the Western Cape, South Africa.

Methamphetamine use among youth in the Western Cape Province of South Africa has increased at alarming rates over the past decade. Although current estimates of youth use exist, they range from 2 - 12%. To identify (i) the prevalence of methamphetamine use in Western Cape youth and (ii) the association between use and known risk factors for methamphetamine use. Data were obtained from 10 000 Western Cape Province Grade 8 learners in 54 secondary schools (mean age 14.0 years). Prevalence was descriptively reported while risk factors for past-month use were modelled in a hierarchical logistic regression with demographic, socioeconomic status, substance use, sexual activity and relationship predictors. Approximately 5% (n=496) of learners had used methamphetamine within their lifetime. Of these users, 65% (n=322) had used in the past month or week. Compared to never users, past-month users were more likely to be male, less likely to have a present or partially present mother, less likely to live in an apartment/flat/brick house, more likely to have used alcohol and tobacco and more likely to report having a same-sex partner. Results replicate previously known methamphetamine risk factors and highlight the need to address methamphetamine use in comprehensive prevention initiatives.

Primary health-care responses to methamphetamine use in Australian Indigenous communities.

Crystal methamphetamine (commonly known as 'ice') use is currently a deeply concerning problem for some Australian Indigenous peoples and can cause serious harms to individual, families and communities. This paper is intended to support best practice responses by primary health-care staff working with Australian Indigenous people who use methamphetamine. It draws on a systematic search of relevant databases to identify literature from January 1999 to February 2014, providing an overview of prevalence, treatment, education and harm reduction, and community responses. The prevalence of methamphetamine use is higher in Indigenous than non-Indigenous communities, particularly in urban and regional settings. No evidence was identified that specifically related to effective treatment and treatment outcomes for Indigenous Australians experiencing methamphetamine dependence or problematic use. While studies involving methamphetamine users in the mainstream population suggest that psychological and residential treatments show short-term promise, longer-term outcomes are less clear. Community-driven interventions involving Indigenous populations in Australia and internationally appear to have a high level of community acceptability; however, outcomes in terms of methamphetamine use are rarely evaluated. Improved national data on prevalence of methamphetamine use among Indigenous people and levels of treatment access would support service planning. We argue for the importance of a strength-based approach to addressing methamphetamine use, to counteract the stigma and despair that frequently accompanies it.

Depression mediates and moderates effects of methamphetamine use on sexual risk taking among treatment-seeking gay and bisexual men.

Mounting evidence suggests a syndemic relation between methamphetamine use and depression to increase sexual risk taking (i.e., HIV transmission risk behavior) among men who have sex with men. This prospective analysis of longitudinal data collected from an outpatient methamphetamine abuse treatment program for gay and bisexual men assessed whether symptoms of depression mediated and/or moderated the associations between methamphetamine use and unprotected insertive/receptive anal intercourse. From November 2005 through October 2007, 167 treatment-seeking gay and bisexual men (63% HIV-positive) enrolled in and attended a 16-week methamphetamine abuse outpatient treatment program. Participants' depressive symptoms, biomarker-confirmed methamphetamine use, and self-reported sexual risk taking were assessed at baseline and follow-up evaluations. Path analysis tested the mediating and moderating effects of depression on the associations between methamphetamine use and unprotected insertive/receptive anal intercourse. Methamphetamine use during the treatment period had a significant indirect (Coef. = -.15; 95% CI [-.23, -.06]), but no direct (Coef. = .11; ns) or total effect (Coef. = -.04; ns) on participants' sexual risk taking after accounting for the significant mediating (Coef. = .56; 95% CI [.33, .78]) and moderating (Coef. = -.03; 95% CI [-.04, -.02]) effects of depression. Depression fully mediated and weakly moderated associations between methamphetamine use and sexual risk taking in this sample. Interventions and treatment programs to reduce sexual risk taking among gay and bisexual men should simultaneously address methamphetamine use and depression to optimize health outcomes.

Initial feasibility and acceptability of a comprehensive intervention for methamphetamine-using pregnant women in South Africa.

The purpose of the present study was to determine the feasibility, acceptability, and initial efficacy of a women-focused intervention addressing methamphetamine use and HIV sexual risk among pregnant women in Cape Town, South Africa. A two-group randomized pilot study was conducted, comparing a women-focused intervention for methamphetamine use and related sexual risk behaviors to a psychoeducational condition. Participants were pregnant women who used methamphetamine regularly, had unprotected sex in the prior month, and were HIV-negative. Primary maternal outcomes were methamphetamine use in the past 30 days, frequency of unprotected sexual acts in the past 30 days, and number of antenatal obstetrical appointments attended. Primary neonatal outcomes were length of hospital stay, birth weight, and gestational age at delivery. Of the 57 women initially potentially eligible, only 4 declined to participate. Of the 36 women who were eligible and enrolled, 92% completed all four intervention sessions. Women in both conditions significantly reduced their methamphetamine use and number of unprotected sex acts. Therefore, delivering comprehensive interventions to address methamphetamine use and HIV risk behaviors among methamphetamine-using pregnant women is feasible in South Africa. Further testing of these interventions is needed to address methamphetamine use in this vulnerable population.

Interim evaluation of a university-community collaboration to address methamphetamine use in a rural Missouri community.

Methamphetamine use remains a significant public health problem. A multifaceted problem requires a collaborative effort. Community partners and university faculty collaborated to address meth use in a rural Missouri county. The objectives for this collaboration were to a) support current community partnerships by working with parents and teachers to incorporate a sustainable drug education curriculum in an elementary school and b) provide learning opportunities for senior nursing students. Various strategies were used in the collaboration, including focus groups with school personnel and piloting the curriculum in a local school. Community members and university faculty worked together in all stages of the collaboration. The collaboration allowed the community to continue and expand its efforts in reducing methamphetamine use. Community and university team members are working together to expand the implementation in additional grades. A real-world community problem can be addressed through a university-community collaboration.

Methamphetamine injection and syringe sharing among a community-recruited sample of injection drug users in Bangkok, Thailand

The recent growth in methamphetamine use internationally has raised concerns about the relationship between methamphetamine use and HIV infection. However, the risks associated with methamphetamine injection have not been fully described, particularly outside of Western countries. Therefore, we sought to examine the relationship between methamphetamine injection and syringe sharing among injection drug users (IDU) in Bangkok, Thailand. Using bivariate statistics and multivariate logistic regression, we examined the prevalence of methamphetamine injection and the relationship between more than weekly methamphetamine injection and syringe sharing among a community-recruited sample of IDU participating in the Mitsampan Community Research Project in Bangkok. During June and July 2009, 311 IDU participated in this study, including 91 (29.3%) women. In total, 114 (36.7%) participants reported having injected methamphetamine ("yaba") twice or more per week in the past six months. In multivariate analyses, after adjustment for potential social, demographic and behavioral confounders, syringe sharing remained independently associated with injecting methamphetamine more than once per week (adjusted odds ratio=2.86, 95% confidence interval: 1.59-5.15). Over one-third of a community-recruited sample of Thai IDU reported more than weekly injection of methamphetamine, and methamphetamine injection was independently associated with syringe sharing. Essential HIV prevention services targeting IDU, such as syringe exchange and evidence-based addiction treatment, should be included in interventional efforts to address methamphetamine use in Thailand.

Drug use and the risk of HIV infection amongst injection drug users participating in an HIV vaccine trial in Bangkok, 1999–2003

Background HIV spread rapidly amongst injecting drug users (IDUs) in Bangkok in the late 1980s. In recent years, changes in the drugs injected by IDUs have been observed. We examined data from an HIV vaccine trial conducted amongst IDUs in Bangkok during 1999–2003 to describe drug injection practices, drugs injected, and determine if drug use choices altered the risk of incident HIV infection. Methods The AIDSVAX B/E HIV vaccine trial was a randomized, double-blind, placebo-controlled trial. At enrolment and every 6 months thereafter, HIV status and risk behaviour were assessed. A proportional hazards model was used to evaluate demographic characteristics, incarceration, drug injection practices, sexual activity, and drugs injected during follow-up as independent predictors of HIV infection. Results The proportion of participants injecting drugs, sharing needles, and injecting daily declined from baseline to month 36. Amongst participants who injected, the proportion injecting heroin declined (98.6–91.9%), whilst the proportions injecting methamphetamine (16.2–19.6%) and midazolam (9.9–31.9%) increased. HIV incidence was highest amongst participants injecting methamphetamine, 7.1 (95% CI, 5.4–9.2) per 100 person years. Injecting heroin and injecting methamphetamine were independently associated with incident HIV infection. Conclusions Amongst AIDSVAX B/E vaccine trial participants who injected drugs during follow-up, the proportion injecting heroin declined whilst the proportion injecting methamphetamine, midazolam, or combinations of these drugs increased. Controlling for heroin use and other risk factors, participants injecting methamphetamine were more likely to become HIV-infected than participants not injecting methamphetamine. Additional HIV prevention tools are urgently needed including tools that address methamphetamine use.

A systematic review of cognitive and behavioural therapies for methamphetamine dependence

The use of methamphetamine is widespread and poses significant challenges for treatment providers. Much of the treatment knowledge about this group has been extrapolated from studies of treatment for cocaine dependence. Medications have been shown to be of limited effectiveness for methamphetamine users, making psychological interventions the treatment of choice. This paper describes a systematic review of cognitive-behavioural and behavioural interventions for methamphetamine users. A systematic search of published literature was undertaken focusing only on randomised trials. There were a relatively small number of intervention studies that compared cognitive-behavioural or behavioural interventions using randomised trial methodology. Most commonly, studies examined cognitive-behaviour therapy (CBT) and/or contingency management (CM). Treatment with CBT appears to be associated with reductions in methamphetamine use and other positive changes, even over very short periods of treatment (two and four sessions). CM studies found a significant reduction of methamphetamine during application of the procedure, but it is not clear if these gains are sustained at post-treatment follow-up. The review highlights that there are effective treatments for methamphetamine dependence. Alcohol and other drug (AOD) clinicians are familiar with these types of interventions and should use them and convey to clients that they are effective. Services and policy makers should ensure that best practice interventions are implemented within AOD services. Psychological intervention is effective in addressing methamphetamine use and dependence. CBT and contingency management are two accessible interventions that are implemented easily within current AOD services. There is still more work to conduct in improving methamphetamine treatment, however, and further research into cognitive-behavioural and behavioural treatments for methamphetamine users is required, with a focus on improving longevity of the effect of intervention and improving effectiveness among more complex presentations.

Contingency management: an evidence‐based component of methamphetamine use disorder treatments

To review briefly some of the available evidence regarding the utility of contingency management in treating methamphetamine use disorders. A literature review was conducted to locate relevant studies for the review. The review suggests that contingency management is likely to be a useful component of treatment strategies designed to address methamphetamine use disorders. Results suggest that contingency management can increase the likelihood of providing methamphetamine-free urine samples during treatment. Evidence suggests that contingency management is a good candidate for inclusion in treatment strategies for methamphetamine addiction.

Methamphetamine use and infectious disease‐related behaviors in men who have sex with men: implications for interventions

Review the current evidence regarding the prevalence of methamphetamine use among men who have sex with men (MSM) and to evaluate the factors that contribute to methamphetamine use and potential for sexual transmission of HIV and other infectious diseases. Databased reports address (1) epidemiology of methamphetamine use in MSM; (2) methamphetamine use and risk behaviors for sexually transmitted infections; and (3) interventions. Methamphetamine use is highly prevalent in MSM. Strong associations between methamphetamine use and HIV-related sexual transmission behaviors are noted across studies of MSM and correspond to increased incidence for HIV and syphilis compared to MSM who do not use the drug. Behavioral treatments produce sustained reductions in methamphetamine use and concomitant sexual risk behaviors among methamphetamine-dependent MSM. Brief screening of methamphetamine use for MSM who seek physical, mental health and substance abuse services is recommended. Behavioral interventions that address methamphetamine use may range from brief interventions to intensive out-patient treatments.