Psychostimulants to reduce stimulant use

Summary of the evidence

  • Likely to be beneficial

Substitution therapy has already proved to be effective for smoking and opioid use. Evidence is emerging around the effectiveness of pychostimulants prescription for stimulants related problems.
Psychostimulants, namely modafinil, methylphenidate, or amphetamines (mixed amphetamine salts, lisdexamphetamine, and dextroamphetamine) were found in a systematic review (Tardelli et al., 2020, 38 RCTs, N = 2889) to be effective in:

  • increasing rates of sustained abstinence [risk ratio (RR) = 1.45, 95% confidence interval (CI) = (1.10, 1.92)] and duration of abstinence [mean difference (MD) = 3.34, 95%CI = (1.06, 5.62)], particularly in patients with cocaine use disorder (although very low-quality evidence).
  • Prescription amphetamines were particularly beneficial in promoting sustained abstinence in patients with cocaine use disorder [RR = 2.44, 95% CI = (1.66, 3.58)], and
  • higher doses of PPs (eg. >60 mg/dose of dextroamphetamine) were particularly efficacious for treatment of cocaine use disorder [RR = 1.95, 95% CI = (1.38, 2.77)].
  • Treatment with prescription amphetamines also yielded more cocaine-negative urines [MD = 8.37%, 95% CI = (3.75, 12.98)].

There was no effect of PPs on the retention in treatment.