Is Bupropion Plus Naltrexone an Effective Treatment for Methamphetamine Use Disorder?

Amphetamines are the second-most commonly used drug in the world and their use is rising in the US. There are currently no FDA-approved medications for treating methamphetamine use disorder (MUD). This multisite randomized controlled trial evaluated the efficacy and safety of extended-release naltrexone (380mg every 3 weeks) plus oral extended-release bupropion (450mg daily), compared with placebo for 6 weeks. The primary outcome was treatment response, defined as at least 3 out of 4 methamphetamine-negative urine drug tests over the last 2 weeks of the study.

• The study enrolled 403 patients with moderate or severe MUD.
• 15% of eligible patients were randomized; 69% of the participants were men.
• Overall, 13.6% of patients in the intervention group had a treatment response, compared with 2.5% in the placebo group; this translates to a number needed to treat of 9.
• The most common adverse effects were gastrointestinal disorders, tremor, malaise, hyperhidrosis, and anorexia.

Comments: Medications that are accessible and effective are urgently needed to treat MUD. Behavioral treatments like cognitive behavioral therapy and contingency management show favorable benefit, although their access remains very limited. This trial demonstrates a possible new treatment for MUD; however, limiting factors may be cost of the treatments and patient preference, both of which were not assessed.

Melissa Weimer, DO

Reference: Trivedi MH, Walker R, Ling W, et al. Bupropion and naltrexone in methamphetamine use disorder. N Engl J Med. 2021;384(2):140–153.