418 No evidence of benefit of psychostimulants for amphetamine abuse or dependence

May 05, 2014

PEARLS 418, January 2014, written by Brian R McAvoy

Clinical question
How effective are psychostimulant medications for amphetamine abuse or dependence?

Bottom line
Psychostimulants (dexamphetamine, bupropion, methylphenidate and modafinil) did not reduce amphetamine use or amphetamine craving and also did not increase sustained abstinence in comparison with placebo. Retention in treatment was similar and low with both treatments. Psychostimulants also did not increase the risk of adverse events intense enough to induce study dropout. Study length ranged from 8 to 20 weeks.

Caveat
The results of this meta-analysis were obtained from only a few studies with small sample sizes, undertaken to test psychostimulants with different stimulant potencies and restricted ranges of doses. Studies were conducted in the US, Australia or Northern Europe. Generalisation of the results to other countries should be made with caution because social, cultural and health system differences can affect the overall treatment outcome. Furthermore, most studies included participants who were dependent upon methamphetamine because amphetamine dependence is rather infrequent.

Context
Amphetamine dependence is a public health problem with medical, psychiatric, cognitive, legal and socioeconomic consequences. To date, no pharmacological treatment has been approved for this disorder, and psychotherapy remains the mainstay of treatment. In recent years, psychostimulants have been investigated as a possible replacement therapy.

Cochrane Systematic Review
Perez-Mana C et al. Efficacy of psychostimulant drugs for amphetamine abuse or dependence. Cochrane Reviews, 2013, Issue 9. Art. No.: CD009695.DOI: 10.1002/14651858. CD009695.pub2. This review contains 11 studies involving 791 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.