A study published today in the January issue of the New England Journal of Medicine suggests that a cocktail of two widely available drugs may be effective as a chemical treatment for methamphetamine use disorder. While the results of the study don’t suggest a cure-all, the combined medications could be a powerful new tool for dealing with a modern and rapidly-growing problem. When participants’ urine was measured for methamphetamines to assess results, 13.6 percent of participants treated with a combination of naltrexone and bupropion responded to treatment, compared to 2.5 percent of participants given a placebo.
According to a CDC report from March of 2020, 1.6 million Americans used methamphetamines between 2015 and 2018, and 52.9 percent of those users were reported as having methamphetamine use disorder. The CDC reports 6.6 cases of methamphetamine use in the trailing 12 months per 1,000 people in the general population.
Though the drug is often associated exclusively with poor rural areas, methamphetamines are a persistent and notorious problem in the LGBTQ community. Compared to the general population, the 2019 National Survey on Drug Use and Health reported that 2.9 percent of lesbian, gay, and bisexual adults use the drug. Methamphetamines are widely used as a party drug; crystal meth is prevalent in both the LGBTQ club scene and at sex parties. Last season on RuPaul’s Drag Race, one of the contestants was named Crystal Methyd.
Anecdotally, I find use of the drug among New York’s gay men cuts across all social and economic strata. In the gay community, meth use is still shrouded in shame and secrecy. Regular users of other drugs who wouldn’t blink at a bump of coke or K often blink hard at being casually offered a bump of crystal meth.
The stigma makes it hard to even speak about the problem, as does the perceived lack of treatment available. Believing, rightly or wrongly, that a problem can’t be fixed can be a major impediment to seeking help. Though the analogy is of course imperfect, the precedent of HIV medications and then PrEP suggests that the availability of treatment correlates with the degree of avoidance that surrounds a common problem in the gay community.
Currently, behavioral and cognitive therapy are the primary forms of intervention for methamphetamine abuse. But methamphetamine use is high among people with low income; people with mental health issues; people living in rural areas; and others for whom sustained access to therapeutic care is precarious or nonexistent. A pharmaceutical intervention reliant on cheap, commonly available drugs stands to make treatment widely accessible for a difficult and persistent problem: In a March 2020 CDC report covering the general population, fewer than a third of people whose drug abuse met criteria for methamphetamine substance disorder received treatment for it. In 2017, methamphetamine was involved in about 15 percent of all drug overdose deaths, according to the CDC.
The same cocktail of naltrexone and bupropion has also shown promise in the treatment of opioid dependence. In recent years, opioid and methamphetamine dependence have had a growing correlation—50 percent of the deaths involving methamphetamine in 2017 also included the use of an opioid. The cocktail’s two components are already commonly used in treatment of alcoholism.
This is one study, and even a proven pharmaceutical intervention isn’t a magic bullet to solve a complex problem like disordered drug use. But the promise of a drug cocktail with a demonstrated effect on methamphetamine dependency offers a new and urgently needed approach. With naltrexone and bupropion available at most pharmacies, the treatment, after further research, has the potential to become an integral part not just of medical treatment, but of an accessible community response.