On January 13th the National Institutes of Health (NIH) released a study that shows a combination of two medications, injectable naltrexone and oral bupropion, is safe and effective in treating methamphetamine use disorder. This combination therapy may be a useful tool, in addition to current approaches to treatment, such as cognitive-behavioral therapy and contingency management interventions, for treating adults with moderate or severe methamphetamine use disorder.
This news comes as methamphetamine overdose is soaring across the United States. According to an eight-year study by the NIH, overdose deaths involving methamphetamines have risen rapidly for all racial and ethnic groups since the study began in 2011. Non-Hispanic American Indians and Alaska Natives have been hit the hardest by the surge, with deaths involving methamphetamines more than quadrupling among this population. The NIH study also found that men are facing much higher overdose rates compared to women among all ethnicities.
In the past, much of our national focus on overdose and overdose death has been directed entirely on opioids. Federal dollars have been funneled into education, prevention, and treatment of opioid use disorder (OUD), but this new data shows us that opioids are not the only substance causing a crisis. Even beyond methamphetamines, the majority of opioid-related overdose deaths involve one or more other substances. For example, cocaine, a stimulant, has been found to be involved in 1 out of every 5 overdose deaths.
By focusing solely on overdose deaths related to the“opioid crisis”, we are doing a disservice to people who are suffering from a substance use disorder that involves other drugs. This can disproportionately affect minority populations. Opioids only came to light as being a crisis in our national rhetoric when they began affecting white, suburban neighborhoods. Communities of color had been facing struggles with opioids and crack cocaine for years prior to opioids becoming an “epidemic”. But rather than getting those people treatment, the nation declared a “War on Drugs” and sent people who used drugs to jails and prisons.
The NIH study of injectable naltrexone and oral bupropion is a huge step in the right direction for the treatment of methamphetamine use. This may also open the door for the possibility of other pharmacotherapies for the treatment of substance use disorder involving other substances.
The next challenge would be ensuring that people who suffer from methamphetamine use disorder would have access to this treatment. We have already seen numerous restrictions and stigma placed on medication treatment for opioid use disorder. The United States Department of Health and Human Services only just recently expanded access to treatment for Opioid Use Disorder after reaching the grim milestone of 83,000 opioid-related deaths in 12 months.
It would be a tragedy if another treatment for substance use disorder were to be available, but inaccessible to the people who need it the most.