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Please note that the information on this page is based on the EMCDDA Annual report 2010: the state of the drugs problem in Europe. Most statistical data relate to the year 2008 (or the last year available).

 
 

Annual report 2010: the state of the drugs problem in Europe
Amphetamines, ecstasy and hallucinogenic substances

Published: 10 November 2010

Treatment

Users of amphetamines generally receive treatment in outpatient drug services which, in countries with a history of a significant amphetamines problem, can be specialised in treating this type of drug problem. Treatment for the most problematic users of amphetamines may be provided in inpatient drug services or in psychiatric clinics or hospitals. This is particularly the case where amphetamines dependence is complicated by co-occurring psychiatric disorders. In Europe, pharmaceuticals (anti-depressants, sedatives or anti-psychotics) are administered for the treatment of early abstinence symptoms at the beginning of detoxification, which is usually provided at specialised inpatient psychiatric departments. In the Czech Republic, methamphetamine users referred to detoxification centres often arrive in a state of acute toxic psychosis, which is typically accompanied by aggressiveness towards both themselves and their surroundings. Such patients often need to be physically restrained, communication with them is difficult, and they usually reject any care. Users with psychotic conditions are treated with atypical antipsychotic medications in inpatient psychiatric facilities. The Czech Republic also reports that, due to the young age of clients and the high frequency of family-related problems, it is common to work with methamphetamine users within a family therapy context.

The lack of a pharmacological substitute for the treatment of amphetamines dependence is mentioned by several countries as a problem for maintaining amphetamines users in treatment. While dexamphetamine is available as a substitute for the treatment of highly problematic users of amphetamines in England and Wales, national guidelines on clinical management of drug dependence recommend against its use for this purpose, due to the lack of demonstrated effectiveness (NTA, 2007).

Treatment effectiveness

Chronic use of methamphetamine can lead to cognitive impairment, and this can reduce the user’s capacity to benefit from psychological, cognitive and behavioural therapies (Rose and Grant, 2008). This may help explain the considerable research efforts that are being made to develop pharmacological interventions. In some cases, the medications being studied are intended to enable the patients to undertake a psychological intervention.

A number of clinical trials on pharmaceuticals for use in treating amphetamines dependence have recently been published or are in progress. Out of nine published studies, six were carried out in the United States, two in Sweden and one in Australia. The substances investigated included the dopamine-reuptake inhibitors methylphenidate and bupropion, for promoting the abstinence in methamphetamine-dependent patients; aripiprazole, an antipsychotic agent; ondansetron, an anti-anxiety agent; amineptine, a psychotropic drug; mirtazapine, an antihistamine; modafinil, a neuroprotective agent; and the opioid receptor antagonist naltrexone. Among all studies, only naltrexone was associated with a significant treatment benefit in terms of reduction of use (either proved by urine samples or self-reported) and rate of continuous abstinence. Studies in the United States are also exploring if citicoline, which may improve mental function in methamphetamine dependent subjects, improves the efficacy of other pharmaceutical treatments.

Finally, a controlled study showed that outpatient treatment supervised by a drug court produced better results than unsupervised treatment. In a clinical study, the addition of contingency management improved the results compared to current treatment alone. A possible vaccine with antidrug monoclonal antibodies for overdose and relapse prevention has also been described in a recent dissertation.

Bibliographic references

NTA (2007), Drug misuse and dependence: UK guidelines on clinical management (available online).

Rose, M.E. and Grant, J.E. (2008), ‘Pharmacotherapy for methamphetamine dependence: a review of the pathophysiology of methamphetamine addiction and the theoretical basis and efficacy of pharmacotherapeutic interventions’, Annals of Clinical Psychiatry 20, pp. 145–55.

About the EMCDDA

The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) is the reference point on drugs and drug addiction information in Europe. Inaugurated in Lisbon in 1995, it is one of the EU’s decentralised agencies. Read more >>

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Page last updated: Friday, 15 October 2010