Artist Riley Storte grew up in Seattle around a family suffering from drug use disorders.
By the age of 14, Storte began to use the drug himself and for the next 16 years fought heroin and methamphetamine addiction. That was until Storte began taking Svoxone, an opioid remedy that shed her desire for heroin.
But Meta had no such drug. And meth helped Stolte concentrate on her art, so she had a hard time stopping using it — she even says it made her “psychiatric”. ..
“I told myself in my head,’I can’t do my art or paint without a little awakening,” Stolte said. “And I believed so too.”
Drugs like Suboxone partially bind to the same opioid receptors in the brain as heroin, but not at high concentrations, but are considered best practices for treating disorders of opioid use. However, addiction to methamphetamine, which is rapidly overtaking heroin as the most common drug associated with overdose mortality in King County, has no comparable drug treatment. There is no definitive study on it.
Data on deaths from overdose in King County show that most contain a combination of opioids and stimulants, but the number of deaths associated with methamphetamine reached 204, the highest recorded last year, and 2013 That number has quadrupled each year. According to local research, if a patient also suffers from methamphetamine, a disorder of opioid use alone will not help the patient to continue with treatment.
Death disproportionately attacks black, indigenous, and homeless people in King County. Nearly 20% of King County overdose deaths involving stimulants in 2019 were among those reported to be homeless. Almost 16% of those who died were blacks, even though less than 7% in King County. American Indians and Alaska Natives accounted for less than a percentage point of the total King County population, but more than 3% of deaths.
Coronavirus is rushing to find effective treatments for methamphetamine use disorders. According to travel restrictions, global pharmaceutical production and supply chains are disrupted, according to the report. United Nations Report About the trend of drug trafficking announced in May.
Methamphetamine is more expensive or harder to obtain for some users in the US, so new reports from healthcare professionals and advocates could now be a great opportunity to bring people into treatment. Insists. For solutions, specifically see if drug-based treatments for methamphetamine use disorders can help people.
But not everyone is optimistic.
Promising signal, But there is nothing definitive — yet
The lack of treatment options for methamphetamine users is frustrating to Dr. Richard Waters, Medical Director of the Home and Street Outreach team at Neighborcare Health. Nine years ago, when he started living in Seattle, stimulant use was not widespread. But over the last six years, it has surged with the homeless crisis on the West Coast, during which some people living on the streets have used meth as a survival tool to stay alert and protect themselves at night. I am reporting.
According to a 2019 client survey of the Washington-wide Syringe Replacement Program, nearly half of those who used methamphetamine said they were interested in reducing or discontinuing its use.
“I had my patients come to my office and wept because they wanted to stop using stimulants, but… despite their strong desire, they retreated to a cycle of craving use and subsequent withdrawal. I will continue,” said Waters.
International studies have shown signs of hope for stimulant medications.
Finding a cure for methamphetamine addiction has become a government priority in Australia, where 1.4% of people over the age of 14 report methamphetamine or amphetamine use within the past year.
In March, Dr. Christy Seefried, a clinical researcher at the National Center for New Drug Research (NCCRED), published a government-sponsored study examining evidence of drug treatment in methamphetamine and amphetamine use disorders. This study examined 43 different clinical trials that tested 23 different drugs, and 5 studies using a class of drugs known as psychostimulants showed “promising signals” for possible treatments. I understand that it is being done.
The two psychostimulants available for study were methylphenidate, known in the US as Ritalin, and dextroamphetamine, a stimulant used to treat ADHD and narcolepsy.
Although clinical trials have not shown that these drugs have been successful in completely blocking stimulant use, some studies have reported less frequent use of stimulants or less withdrawal symptoms. There was a subject.
The researchers’ findings were not particularly conclusive. Results varied, and studies measured and selected results differently, making analysis more difficult.
“We haven’t hit that drug substitute that we can say is actually effective,” Seafried said. “I need more research.”
To that end, a group of Seattle-based researchers, advocates, and healthcare professionals have compiled a report calling on local governments to invest in research that further explores stimulant replacement therapy.
One of the authors of the report, Dr. Judithsui, an associate professor at the University of Washington School of Medicine, says a clinical trial to see if long-acting methylphenidate is effective in people who have already been prescribed methadone for treatment. Suggested their opioid addiction.
Her interest in finding potential drug treatments stems from her own experience as a primary care provider at the methadone clinic. Patients present with various medical complications associated with the use of meta, including heart problems, dental problems, and psychosis.
“As a doctor, I feel helped by the lack of other options that need to be offered to more patients suffering from methamphetamine use disorders,” said Tsai.
Waters, a residential and street outreach team at Neighborcare Health, supports the idea of a randomized controlled trial as Tsui proposed.
“I think it’s perfect because it needs to happen,” Waters said. “We have previously had studies on methylphenidate, and the results provide the light of hope.”
But part of the addiction medicine community is skeptical-the doctor who treated Stolte’s stimulant use in ADHD medicine, Dr. Includes Richard Ries.
Reese, the founder of the Mental Health and Addiction Services Department at Harbourview Medical Center, has seen years of collaboration with patients and conducting and reviewing studies only in the very specific groups that benefit from drug therapy. I was told. Stopping their use of stimulants and otherwise being relatively stable in their lives.
When Ries prescribed ADHD Stolte Methylphenidate or Ritalin, she quickly discontinued methamphetamine use.
“I immediately noticed. My thoughts slowed down and felt a bit more calm-less running around in the ward and causing a turmoil,” Stolte said with a laugh.
That was a year ago. On June 11, she woke up before 5am. She has been cool for the first time since she was 14 years old.
However, people with ADHD are likely to be a minority of stimulant users, although percentages vary widely among studies, Reese said.
One of the reasons Leith isn’t expecting a substitute is that the high concentrations from methamphetamine are much more potent than heroin and prescribed ADHD drugs, and release so much dopamine.
“In terms of alcohol, some people drink five-half a day and say, “OK, I’ll give you two glasses of liquor,” says Reese. “If you are going to prescribe it and think you are going to substitute it, you will have to find a doctor somewhere to try to prescribe an amazing amount.”
Safe supply
Dr. Caleb Bantagreen, senior research scientist at UW’s Institute for Alcohol and Drug Abuse, held an “Awakening Summit” in Seattle last year to discuss interventions that Tsui studied. Banta-Green said, “Ritarine was prescribed for metausers with ADHD, and mirtazapine was prescribed for users with depression.” Has some evidence.” Banta-Green says it is worth further investigation.
“It doesn’t make sense to me to find all your hopes in one particular medicine,” Banta Green said. “There’s something there (with methylphenidate)… but it’s not as convincing as what we see in opioids, and we’ve been looking for a long time.”
The more preferred approach among research scientists does not include medicine at all. Called “emergency management,” the system rewards patients for less frequent use of drugs and complete cessation of drugs. However, despite the success of this approach in multiple studies, homeless people were eight times more likely to discontinue treatment than detained participants, One of the top researchers told the Seattle Times last year..
British Columbia is trying another tack. In late March, fearing that a pandemic would make the street drug supply even more dangerous, British Columbia began allowing healthcare professionals to provide street drug users with an alternative drug prescription. Called “safe supply,” this strategy aims to reduce overdose in vulnerable people on the road and those at high risk of coronavirus exposure to drug use.
The Providence Healthcare Crosstown Clinic in Vancouver, BC, has been prescribing long-acting dextroamphetamine to a small number of metausers since 2016.
Dr. Scott Hanson, a doctor at the Crosstown Clinic, said: “I think it’s effective. [but] It doesn’t work for everyone in our population. “
Hanson said sustained-release dextroamphetamine tablets tended to be better for people seeking energy throughout the day than for those seeking immediate effect.
However, while policy makers and healthcare professionals discuss treatment options, Tui emphasizes that advances in the treatment of opioid use disorders may be diminished by failure to address coexisting stimulant addiction.
“We have made great strides in improving access to treatments for opioid use disorders,” Tsai said. “But if the co-administration of methamphetamine is not adequately addressed, it can prevent patients from achieving the best therapeutic results.”
