Pharmacotherapy for amphetamine and/or methamphetamine use

A systematic review (Siefried et al., 2020, 43 RCTs, N = 4065) addressing 23 different types of pharmacotherapies for amphetamine and/or methamphetamine use, alone or in combination, found:

• no evidence of effectiveness of any pharmacotherapy in treating amphetamine and/or methamphetamine dependence. While some drugs demonstrated results that were statistically significantly better than placebo outcomes, the studies were generally small and the samples biased and study protocol completion was low making it impossible to recommend any intervention.

Some weak but positive findings have been demonstrated with stimulant agonist treatment (dexamphetamine and methylphenidate), naltrexone and topiramate.
Future research should address the heterogeneity of AMPH/MA dependence (e.g. coexisting conditions, severity of disorder, differences between MA and AMPH dependence) and the role of psychosocial intervention.

Treatment of amphetamine and methamphetamine use disorder with mirtazepine was found in a systematic review with meta-analysis (Naji et al., 2022, 2 RCTs) to have no effect against placebo to improve:

• retention in treatment (RR=1.01, 95% CI: 0.91, 1.12; n = 180; moderate certainty evidence)
• depression symptom severity (mean difference [MD]=0.45, 95% CI: -2.88, 3.78; n = 53; moderate certainty evidence)