Drugs to help end amphetamine dependence are not very helpful, and more research is needed.

Srisurapanont M, Jarusuraisin N, Kittirattanapaiboon P

Published Online:

July 16, 2008

As amphetamines can produce feelings of euphoria, they are widely manufactured. Dependence on amphetamines is more common than cocaine and heroin dependence combined, and ending dependence on amphetamines can be as difficult as it is for cocaine and heroin. Amphetamines are also prescribed for some health problems, and ongoing use can lead to dependence. The review found there was very little evidence about ways to help end dependence on amphetamines. There is some evidence that the drugs fluoxetine and
imipramine can be some help, but not enough to help reduce amphetamine use. More research is needed.

Abstract (click to read)

Background:

Amphetamine use is of concern because it causes a variety of devastating health physical and neurological consequences, including amphetamine-induced mental disorders.

Objectives:

To investigate risks, benefits and costs of a variety of treatments for amphetamine dependence or abuse.

Search strategy:

Electronic searches: The specialised register of trials of the Cochrane Group on Drugs and Alcohol (until February 2003), MEDLINE (1966-December 2000), EMBASE (1980-February 2001), CINAHL (1982-January 2001), Cochrane Controlled Trials Register (Cochrane Library 2000 issue 4). References of obtained articles were searched.

Selection criteria:

All relevant randomised controlled trials (RCTs) and clinical controlled trials (CCTs) were included. Participants were people with amphetamine dependence or abuse, diagnosed by any set of criteria. Any kinds of biological and psychological treatment both alone and combined were examined. A variety of outcomes, for example, number of treatment responders, score changes, were considered.

Data collection and analysis:

Two reviewers evaluated and extracted the data independently. The dichotomous data were extracted on an intention-to-treat basis, using Relative Risk in to assess data. The Weighted Mean Difference was used to assess the continuous data.

Main results:

Fluoxetine, amlodipine, imipramine and desipramine have been investigated in four randomised-controlled trials. In comparison to placebo, short-term treatment of fluoxetine (40 mg/day) significantly decreased craving. In comparison to imipramine 10 mg/day, medium-term treatment of imipramine 150 mg/day significantly increased the duration of adherence to treatment. All four drugs had no benefits on a variety of outcomes, including amphetamine use.

Authors' conclusions:

Fluoxetine, amlodipine, imipramine and desipramine have very limited benefits for amphetamine dependence and abuse. Fluoxetine may decrease craving in short-term treatment. Imipramine may increase duration of adherence to treatment in medium-term treatment. Apart from these, no other benefits can be found. This limited evidence suggests that no treatment has been demonstrated to be effective for the treatment of amphetamine dependence and abuse.

Although there is a large number of people with amphetamine dependence and abuse worldwide, very few controlled trials in this issue have been conducted. As the previous treatment trials show no promising result, other treatments, both biological and psychosocial, should be further investigated. However, the results of neurotoxic studies of amphetamines are also crucial for the study designs appropriate for further treatment studies for amphetamine dependence and abuse.

This record should be cited as:

Srisurapanont M, Jarusuraisin N, Kittirattanapaiboon P. Treatment for amphetamine dependence and abuse. Cochrane Database of Systematic Reviews 2001, Issue 4. Art. No.: CD003022. DOI: 10.1002/14651858.CD003022

Assessed as up to date:

August 2, 2001

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Primary Review Group:

Drugs and Alcohol Group

Health topics:

Tobacco, drugs, & alcohol dependence > Amphetamine

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Drugs to help end amphetamine dependence are not very helpful, and more research is needed.

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