Pharmacotherapies to reduce stimulant use in comorbid opioid users

Pharmacotherapies (namely 23 different medications, including anticonvulsants, antidepressants, antipsychotics, dopamine agonists, medications for OUD, medications approved by the FDA for other substance use disorders (SUDs), psychostimulants, and various other pharmacotherapies) were found in a systematic review (Chan et al., 2020, 34 RCTs) to have no effect in:

• reducing stimulant use
• improving abstinence

The review found moderate-strength evidence that antidepressants (desipramine, bupropion, and fluoxetine) worsened retention. There was moderate- strength evidence that disulfiram worsened treatment retention (N = 605, RR 0.86, 95 % CI 0.77 to 0.95).

Treatment with psychostimulants warrant further study as the review found promising results that it may reduce cocaine use.

The majority of studies used methadone concurrently with the study medication, three studies used buprenorphine, and one study used diacetylmorphine. Also the majority of the studies enrolled participants who were already receiving opioid maintenance treatment.