Higher doses of prescription psychostimulants, treatment duration positively linked to longer retention
By Elana Gotkine HealthDay Reporter
MONDAY, Dec. 4, 2023 (HealthDay News) — For individuals with amphetamine-type stimulant use disorder (ATSUD), prescription psychostimulants (PPs) may reduce ATS use and craving, according to a review published in the November issue of Addiction.
Heidar Sharafi, Ph.D., from the Centre Hospitalier de l’Université de Montréal, and colleagues pooled results from randomized placebo-controlled trials (RCTs) to assess the efficacy and safety of PPs for ATSUD. The meta-analysis included 10 RCTs with 561 participants; seven trials studied methylphenidate and three studied dextroamphetamine for two to 24 weeks.
The researchers found that end-point craving was significantly decreased with PPs (standardized mean difference, –0.29), while the decrease was not statistically significant for ATS use, as assessed by urine analysis. No effect was seen for self-reported ATS use, retention in treatment, dropout following adverse events, early-stage craving, withdrawal, or depressive symptoms. After removing studies with a high risk for bias, treatment was associated with a significant reduction in urine analysis positive for ATS in sensitivity analysis. There was a negative association seen for methylphenidate and high doses of PPs with ATS use by urine analysis in subgroup analyses, while longer retention was seen in association with higher doses of PPs and treatment duration (≥20 weeks).
“Our results suggest that relatively potent PP agonists, especially when used in high doses, may be more effective than placebo in diminishing ATS use, increasing retention in treatment and decreasing craving among individuals with ATSUD,” the authors write.
Several authors disclosed ties to the pharmaceutical industry.
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