Bupropion plus naltrexone could work for methamphetamine use disorder

Methamphetamine use is soaring in the United States, but no available treatment exists—unlike medications authorized to treat opioid use disorder. But researchers think they may have discovered some hope for patients with methamphetamine use disorder.

Trivedi and colleagues found that bupropion plus naltrexone for methamphetamine use disorder had more positive outcomes among participants who received the combination than those in the placebo group. Their findings were published in the New England Journal of Medicine on January 14, 2021.

Although naltrexone plus bupropion to treat methamphetamine use disorder has not been well studied, small studies have suggested some efficacy when the drugs were used individually.

Trivedi and the research team conducted a two-stage, placebo-controlled trial, which involved extended-release injectable naltrexone (380 mg every 3 weeks) plus oral extended-release bupropion (450 mg/day). This combination was compared with placebo in 403 adults with moderate or severe methamphetamine use disorder.

The primary outcome was a response defined as at least three methamphetamine-negative urine samples out of four samples obtained at the end of stage 1 or stage 2.

In the first stage, the researchers found that 18 of 109 participants (16.5%) in the naltrexone–bupropion group had a response, and 10 of 294 participants (3.4%) in the placebo group had a response.

In the second stage, 225 individuals took part in the study. In this stage, 13 of 114 study participants (11.4%) in the naltrexone–bupropion group had a response, and 2 of 111 participants (1.8%) in the placebo group had a response.

The response rate across the two stages was 13.6% with the combination treatment, and 2.5% with placebo.

Study authors conclude that: “Among adults with methamphetamine use disorder, the response over a period of 12 weeks among participants who received extended-release injectable naltrexone plus oral extended-release bupropion was low but was higher than that among participants who received placebo.”