Stimulant use disorders, specifically cocaine and methamphetamine use, present ongoing public health problems in the United States, with major medical, psychiatric, cognitive, socioeconomic, and legal consequences.

Currently there are no accepted FDA-approved pharmacotherapy treatment options available for cocaine or methamphetamine use disorders. Several pharmacotherapies have been proposed as possible experimental interventions to promote reduction in use or cessation. Currently, psychotherapy (including cognitive behavioral therapy, drug counseling, relapse prevention, etc) is offered as the primary treatment for stimulant addiction. In addition, contingency management strategies use incentives to increase engagement in treatment and reduce drug use. In order to guide future research and policy decisions for the Veterans Health Administration (VHA), the Office of Mental Health and the Seattle and Philadelphia Centers for Substance Abuse Treatment & Education (CESATE) asked the Veterans Affairs Evidence-based Synthesis Program (ESP) to provide an up-to-date examination of the benefits and risks of various pharmacologic treatments of stimulant use disorder. Specifically, this review examined 1) the benefits and harms of pharmacotherapy for cocaine use disorder, 2) subpopulations for whom different forms of pharmacotherapy are most/least effective for cocaine use disorder, 3) the benefits and harms of pharmacotherapy for amphetamine/methamphetamine use disorder, and 4) subpopulations for whom different forms of pharmacotherapy are most/least effective for amphetamine/methamphetamine use disorder.

Contents

• Preface
• Acknowledgments
• Executive Summary
  • Introduction
  • Methods
  • Results
  • Discussion
  • Abbreviations Table
• Introduction
• Methods
  • Topic Development
  • Search Strategy
  • Study Selection
  • Data Abstraction
  • Quality Assessment
  • Data Synthesis
  • Rating the Body of Evidence
  • Literature Flow
  • Key Question 1. What are the benefits and harms of pharmacotherapy for cocaine use disorder?
  • Key Question 2. Are there known subpopulations for whom different forms of pharmacotherapy is most/least effective for cocaine use disorder?
  • Key Question 3. What are the benefits and harms of pharmacotherapy for Amphetamine/methamphetamine use disorder?
  • Key Question 4. Are there known subpopulations for whom different forms of pharmacotherapy is most/least effective for amphetamine/methamphetamine use disorder?
• Summary and Discussion
  • Limitations
  • Research Gaps/Future Research
  • Conclusions
• References
• Appendix A. Search Strategies
• Appendix B. Technical Expert Panel
• Appendix C. Study Selection
• Appendix D. Quality Assessment Criteria
• Appendix E. Peer Reviewer Comments and Author Responses

Suggested citation:

Chan B, Kondo K, Ayers C, Freeman M, Montgomery J, Paynter R, and Kansagara D. Pharmacotherapy for Stimulant Use Disorders: A Systematic Review of the Evidence. VA ESP Project #05-225; 2018.

This report is based on research conducted by the Evidence-based Synthesis Program (ESP) Center located at the Portland VA Health Care System, Portland, OR funded by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative. The findings and conclusions in this document are those of the author(s) who are responsible for its contents; the findings and conclusions do not necessarily represent the views of the Department of Veterans Affairs or the United States government. Therefore, no statement in this article should be construed as an official position of the Department of Veterans Affairs. No investigators have any affiliations or financial involvement (eg, employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties) that conflict with material presented in the report.