While the opioid epidemic has been getting all the attention in recent years, the rapidly growing problem of stimulant addiction has gone mostly unnoticed. While opioids are certainly a bigger problem at the moment, having caused nearly 50,000 deaths in the US in 2017, at the current rate of growth, stimulants will soon catch up. Between 2011 and 2016, deaths involving cocaine use more than doubled and in the same period, deaths related to methamphetamine use tripled. Often, the areas hardest hit by the growth of stimulant use are already struggling to deal with the opioid epidemic. What’s more, while we have medications like Narcan that can reverse an opioid overdose and methadone and buprenorphine to help people recover from opioid use disorder, there are currently no similar medications for stimulants. However, there are some medications that show some potential and may be used in the near future.
For Initiating Abstinence
A big problem for people who want to quit stimulants is the initial withdrawal period. This typically includes depression, fatigue, sleep disturbance, changes in appetite, and irritability. Getting through this rough period is necessary for recovery but worse withdrawal symptoms make quitting harder. Here are some medications that might help initiate abstinence.
Modafinil
Modafinil is a mild stimulant currently approved to treat narcolepsy. It may relieve withdrawal symptoms by enhancing the effect of the excitatory neurotransmitter glutamate, which is typically depleted after long periods of cocaine use. Modafinil has been shown to reduce self-administration of cocaine in animal studies. It has also been shown in human studies to block the euphoric effects of cocaine. Two clinical studies have found that modafinil increases abstinence in recovering cocaine users and led to better evaluations by clinicians. There are a couple of drawbacks though. First, it doesn’t seem to help patients addicted to both cocaine and alcohol. Second, modafinil keeps you awake, so it’s not good for patients with bipolar disorder or psychosis.
Propranolol
Propranolol is a beta blocker that has shown promise in relieving severe cocaine withdrawal. Beta blockers are typically used for angina and high blood pressure. They work by reducing the effect of adrenaline on the body and they therefore also reduce anxiety. People withdrawing from cocaine often experience intense anxiety and agitation because of their heightened sensitivity to adrenaline. Several studies have found that beta blockers, and propranolol in particular, lessen the severity of withdrawal symptoms and lead to lower levels of self-administration of cocaine. One study found propranolol increased the completion rate of a seven-week outpatient treatment program by more than 60 percent. The main drawback appears to be that it may not be safe for people who have already had cocaine-related heart problems.
Preventing Relapse
Once the patient has made it through the worst of the withdrawal symptoms, it’s time to start working on recovery. The following medications have shown promise in preventing cocaine relapse.
Gamma-Vinyl GABA
This is a medication for epilepsy that inhibits an enzyme that breaks down the inhibitory neurotransmitter GABA, increasing its concentration in the brain. This is thought to blunt the dopamine response to cocaine, making its use less rewarding. GVG has been shown in animal studies to reduce rodents’ self-administration of cocaine, amphetamine, and methamphetamine.
Topiramate
Like GVG, topiramate increases levels of GABA in the brain, making stimulant use less rewarding. However, it also weakens the effect of the excitatory neurotransmitter glutamate, which performs the opposite function of GABA. Two small studies have found that cocaine-dependent patients achieved higher rates of abstinence when given topiramate. Although it appears to be effective, it does have some significant drawbacks. Side effects may include tiredness, memory problems, metabolic acidosis, and acute glaucoma.
Disulfiram
Disulfiram, also known as Antabuse, has long been used to treat alcohol use disorder. It blocks alcohol metabolism in liver, causing you to get violently ill if you drink alcohol. It works in a similar sort of way with cocaine. Disulfiram blocks the metabolism of cocaine, leading to extremely high levels of cocaine and dopamine when cocaine is used. Instead of causing euphoria, this makes the user intensely anxious. Several studies have found that Disulfiram reduces cocaine use. Since many people addicted to cocaine are also addicted to alcohol, disulfiram might be an effective way to treat both at once. Side effects include tiredness, headache, and metallic taste in mouth. You shouldn’t use it if you have heart disease or psychosis.
Naltrexone
Naltrexone is a medication currently used to treat both opioid and alcohol use disorders. It works by blocking opioid receptors in the brain, preventing the euphoric effects of opioids or alcohol. At least one study has found that it significantly reduces the euphoric effects of methamphetamine as well. The study found that naltrexone reduced cravings and also that patients who were given naltrexone and then given a dose of methamphetamine had lower heart rates than those who were given a placebo. The naltrexone group also had lower heart rates when presented with meth-related paraphernalia. Other studies have found that naltrexone combined with the the antidepressant bupropion may help people recover from meth addiction.
Bupropion
Bupropion is an antidepressant that has been found to help people quit smoking. It appears to improve your mood by inhibiting the reuptake of dopamine, leading to higher dopamine levels in the brain’s reward center and easing withdrawal symptoms. Unlike other medications that may work for both cocaine and methamphetamine dependence, bupropion appears to only work for methamphetamine dependence. The effect of bupropion in studies has been mild. It has little effect on people with severe dependencies, but it helped people with more moderate use disorders, which is why researchers are optimistic it can work well when paired with naltrexone.
If you or someone you love is struggling with stimulant addiction or mental illness, we can help. Recovery Ways is a premier drug and alcohol addiction treatment facility located in Salt Lake City, Utah. We have the resources to effectively treat a dual diagnosis. Our mission is to provide the most cost-effective, accessible substance abuse treatment to as many people as possible. Request information online or call us today at 1-888-986-7848.
