title: Bupropion for the treatment of methamphetamine dependence.
abstract: Bupropion was tested for efficacy in increasing weeks of abstinence in methamphetamine-dependent patients, compared to placebo. This was a double-blind placebo-controlled study, with 12 weeks of treatment and a 30-day follow-up. Five outpatient substance abuse treatment clinics located west of the Mississippi participated in the study. One hundred and fifty-one treatment-seekers with DSM-IV diagnosis of methamphetamine dependence were consented and enrolled. Seventy-two participants were randomized to placebo and 79 to sustained-release bupropion 150 mg twice daily. Patients were asked to come to the clinic three times per week for assessments, urine drug screens, and 90-min group psychotherapy. The primary outcome was the change in proportion of participants having a methamphetamine-free week. Secondary outcomes included: urine for quantitative methamphetamine, self-report of methamphetamine use, subgroup analyses of balancing factors and comorbid conditions, addiction severity, craving, risk behaviors for HIV, and use of other substances. The generalized estimating equation regression analysis showed that, overall, the difference between bupropion and placebo groups in the probability of a non-use week over the 12-week treatment period was not statistically significant (p=0.09). Mixed model regression was used to allow adjustment for baseline factors in addition to those measured (site, gender, level of baseline use, and level of symptoms of depression). This subgroup analysis showed that bupropion had a significant effect compared to placebo, among male patients who had a lower level of methamphetamine use at baseline (p<0.0001). Comorbid depression and attention-deficit/hyperactivity disorder did not change the outcome. These data suggest that bupropion, in combination with behavioral group therapy, was effective for increasing the number of weeks of abstinence in participants with low-to-moderate methamphetamine dependence, mainly male patients, regardless of their comorbid condition.
authors.affiliation: Clinical Medical Branch, Division of Pharmacotherapies and Medical Consequences, National Institutes of Health, National Institute on Drug Abuse, Bethesda, MD, USA. ae8a@nih.gov
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Elkashef
authors.forename: Richard A
authors.initials: RA
authors.lastname: Rawson
authors.forename: Ann L
authors.initials: AL
authors.lastname: Anderson
authors.forename: Shou-Hua
authors.initials: SH
authors.lastname: Li
authors.forename: Tyson
authors.initials: T
authors.lastname: Holmes
authors.forename: Edwina V
authors.initials: EV
authors.lastname: Smith
authors.forename: Nora
authors.initials: N
authors.lastname: Chiang
authors.forename: Roberta
authors.initials: R
authors.lastname: Kahn
authors.forename: Frank
authors.initials: F
authors.lastname: Vocci
authors.forename: Walter
authors.initials: W
authors.lastname: Ling
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: Pearce
authors.forename: Michael
authors.initials: M
authors.lastname: McCann
authors.forename: Jan
authors.initials: J
authors.lastname: Campbell
authors.forename: Charles
authors.initials: C
authors.lastname: Gorodetzky
authors.forename: William
authors.initials: W
authors.lastname: Haning
authors.forename: Barry
authors.initials: B
authors.lastname: Carlton
authors.forename: Joseph
authors.initials: J
authors.lastname: Mawhinney
authors.forename: Dennis
authors.initials: D
authors.lastname: Weis
mesh_terms: D000328:Adult; D019969:Amphetamine-Related Disorders / Q000188:drug therapy* / Q000523:psychology / Q000652:urine; D016642:Bupropion / Q000627:therapeutic use*; D018765:Dopamine Uptake Inhibitors / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008694:Methamphetamine / Q000009:adverse effects* / Q000652:urine; D008875:Middle Aged; D008922:Mississippi / Q000453:epidemiology; D011613:Psychotherapy / Q000379:methods; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D018765:Dopamine Uptake Inhibitors; D016642:Bupropion; D008694:Methamphetamine