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Please note that the information on this page is based on the EMCDDA Annual report 2011: the state of the drugs problem in Europe. Most statistical data relate to the year 2009 (or the last year available).

 
 

Annual report 2011: the state of the drugs problem in Europe
Amphetamines, ecstasy, hallucinogens, GHB and ketamine

Published: 15 November 2011

Treatment

Problem amphetamines use

The treatment options available for amphetamines users in European countries often follow the national history and patterns of problem amphetamines use, which differ considerably between countries. In western and southern European countries, treatment systems have mainly specialised in responding to the needs of opioid users. Despite the low levels of problem amphetamines use in these countries, the lack of dedicated services may hinder access to treatment for such users, especially for more socially integrated amphetamine users (EMCDDA, 2010). In those northern and central European countries with a long history of treating amphetamines use, some programmes are tailored towards the needs of amphetamines users. In the central and eastern European countries where significant problem amphetamines use is more recent, treatment systems are primarily geared towards problem opioid users and have been slow to address the needs of amphetamines users. A 2008 survey of national experts, found that less than half of European countries report the availability of specialist treatment programmes for users of amphetamines who actively seek treatment.

Psychosocial treatment provided in outpatient drug services is the most common form of treatment for amphetamines users. The more problematic users, for example those whose amphetamines dependence is complicated by co-occurring psychiatric disorders, may receive treatment in inpatient drug services, psychiatric clinics or hospitals. In Europe, pharmaceuticals such as anti-depressants, sedatives and anti-psychotics are administered for the treatment of abstinence symptoms at the beginning of detoxification, which is usually provided at specialist inpatient psychiatric departments. Longer-term treatment with antipsychotics is sometimes prescribed in cases of lasting psychopathologies due to chronic use of amphetamines. European professionals report that the psychiatric problems often presented by problem amphetamines users are difficult to handle within the therapeutic context. In Hungary, the first professional protocol dealing with the treatment of amphetamines users was published by the Ministry of Health at the beginning of 2008. The protocol covers diagnosis, the indicated structure of medically assisted and drug-free treatment, and other therapies and rehabilitation.

Studies on treatment of amphetamines dependence

Although some limited substitution prescribing is reported in the Czech Republic and the United Kingdom, there is currently no evidence available to support the efficacy of this approach. Clinicians are, however, actively exploring pharmacological therapies that may be helpful in treating amphetamines dependence. The central nervous system stimulant dextroamphetamine, when tested among methamphetamine patients, gave positive results for reduction of craving and withdrawal symptoms, and for retaining clients in treatment, but did not reduce use of methamphetamine compared to a placebo (Galloway et al., 2011; Longo et al., 2010). Studies testing the effect of Modafinil, a drug used to regulate sleepiness, on methamphetamine dependent individuals, found possible improvements in working memory (Kalechstein et al., 2010), but no difference compared to a placebo for levels of drug use, retention in treatment, depression or craving (Heinzerling et al., 2010).

Bupropion, an antidepressant that has been used to assist smoking cessation, was piloted with a small group of methamphetamine dependent men who have sex with men (Elkashef et al., 2008); a more powerful study is needed to confirm the positive results found. Another pilot study, aiming to control the symptoms of attention deficit hyperactivity disorder in problem amphetamine users, combined sustained release methylphenidate with weekly sessions of skills training, but no difference with the placebo group was found (Konstenius et al., 2010).

A number of ongoing trials have been registered in this area, including studies on extended-release naltrexone for amphetamine dependence, and for methamphetamine dependence, studies on monoamine antagonist, an angiotensin converting enzyme inhibitor, N-acetylcysteine, rivastigmine, and varenicline.

Psychological and behavioural interventions for methamphetamine problems are the focus of a small number of studies. An Australian study attempted to compare two psychological approaches for methamphetamine use, but participant drop-out was too high to obtain significant results (Smout et al., 2010). Ongoing trials registered in this area are studying the impact of motivational interviewing and cognitive behavioural skills training on methamphetamine dependence.

Gamma-hydroxybutyrate dependence and treatment

Dependence on gamma-hydroxybutyrate (GHB) is a recognised clinical condition, with a potentially severe withdrawal syndrome when the drug is abruptly discontinued following regular or chronic use. There is evidence that physical dependence may occur in recreational users, and cases of withdrawal symptoms on cessation of use GHB and its precursors have been documented. GHB dependence has also been reported among former alcoholics (Richter et al., 2009).

Available studies mainly focus on the description of GHB withdrawal syndrome and related complications, which can be difficult to recognise in emergency cases (van Noorden et al., 2009). These symptoms may include unrest, anxiety attacks, insomnia, sweating, tachycardia, and hypertension. Patients in withdrawal may also develop psychosis and delirium. Mild withdrawal can be managed in outpatient settings, otherwise inpatient supervision is recommended. As yet, no standard protocols have been devised for the treatment of GHB withdrawal syndrome.

Benzodiazepines and barbiturates are the pharmaceuticals most commonly used to treat acute problems related to GHB use. In the United States, a small study is in progress to compare the benzodiazepine lorazepam with the barbiturate pentobarbital for the reduction of subjective withdrawal symptoms in GHB-dependent individuals. In the Netherlands, research is now being conducted to establish evidence-based guidelines for the treatment of GHB dependence.

Footnotes

Bibliographic references

Elkashef, A.M., Rawson, R.A., Anderson, A.L., Li, S.H., Holmes, T. et al. (2008), 'Bupropion for the treatment of methamphetamine dependence', Neuropsychopharmacology 33(5), pp. 1 162-70.

EMCDDA (2010), Problem amphetamine and methamphetamine use in Europe, Selected issue, Publications Office of the European Union, Luxembourg.

Galloway, G.P., Buscemi, R., Coyle, J.R., Flower, K., Siegrist, J.D. et al. (2011), 'A randomized, placebo-controlled trial of sustained-release dextroamphetamine for treatment of methamphetamine addiction', Clinical Pharmacology & Therapeutics 89(2), pp. 276-82.

Heinzerling, K.G., Swanson, A.N., Kim, S., Cederblom, L., Moe, A. et al. (2010), 'Randomized, double-blind, placebo-controlled trial of modafinil for the treatment of methamphetamine dependence', Drug and Alcohol Dependance 109(1-3), pp. 20-9.

Kalechstein, A.D., De La Garza, R. and Newton, T.F. (2010), 'Modafinil administration improves working memory in methamphetamine-dependent individuals who demonstrate baseline impairment', American Journal on Addictions 19(4), pp. 340-4.

Konstenius, M., Jayaram-Lindstrom, N., Beck, O. and Franck, J. (2010), 'Sustained release methylphenidate for the treatment of ADHD in amphetamine abusers: a pilot study', Drug and Alcohol Dependence 108(1-2), pp. 130-3.

Longo, M., Wickes, W., Smout, M., Harrison, S., Cahill, S. and White, J.M. (2010), 'Randomized controlled trial of dexamphetamine maintenance for the treatment of methamphetamine dependence', Addiction 105(1), pp. 146-54.

Richter, C., Romanowski, A. and Kienast, T. (2009), 'Gamma-Hydroxybutyrat (GHB)-Abhängigkeit und -Entzug bei vorbestehender Alkoholabhängigkeit', Psychiatrische Praxis 36(7), pp. 345-7.

Smout, M.F., Longo, M., Harrison, S., Minniti, R., Wickes, W. and White, J.M. (2010), 'Psychosocial treatment for methamphetamine use disorders: a preliminary randomized controlled trial of cognitive behavior therapy and Acceptance and Commitment Therapy', Substance Abuse 31(2), pp. 98-107.

Van Noorden, M.S., van Dongen, L.C., Zitman, F.G. and Vergouwen, T.A. (2009), 'Gamma-hydroxybutyrate withdrawal syndrome: dangerous but not well-known', General Hospital Psychiatry 31(4), pp. 394-6.

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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, 28 October 2011