title: Bupropion for the treatment of methamphetamine dependence in non-daily users: a randomized, double-blind, placebo-controlled trial.
abstract: OBJECTIVE
  Bupropion was tested for efficacy to achieve methamphetamine (MA) abstinence in dependent, non-daily users.
  
  
  METHODS
  A randomized, double-blind, placebo-controlled trial, with 12-week treatment and 4-week follow-up, was conducted with 204 treatment-seeking participants having MA dependence per DSM-IV, who used MA on a less-than-daily basis. 104 were randomized to matched placebo and 100 to bupropion, sustained-release 150mg, twice daily. Participants were seen three times weekly to obtain urine for MA and bupropion assays, study assessments, and thrice weekly, 90-min, group psychotherapy. There was no biomarker for placebo adherence. The primary outcome was achievement of abstinence throughout the last two weeks of treatment; 'success' requiring at least two urine samples during each of Weeks 11 and 12, and all samples MA-negative (<300ng/mL).
  
  
  RESULTS
  Bupropion and placebo groups did not differ significantly in the percentage achieving abstinence for the last 2 weeks of treatment (chi-square, p=0.32). Subgroup analysis of participants with lower baseline MA use (≤18 of last 30 days before consent) also revealed no difference in success between groups (p=0.73). Medication adherence per protocol (detectable bupropion, >5ng/mL, in ≥50% of urine samples from Study Weeks 1-10 and ≥66% of urine samples from Weeks 11 to 12) was achieved by 47% of participants taking bupropion.
  
  
  CONCLUSIONS
  These data indicate that bupropion did not increase abstinence in dependent participants who were using MA less-than-daily. Medication non-adherence was a limitation in this trial. Psychosocial therapy remains the mainstay of treatment for MA dependence. Further research on subgroups who may respond to bupropion may be warranted.
authors.affiliation: National Institutes of Health, National Institute on Drug Abuse, Division of Pharmacotherapies and Medical Consequences, Bethesda, MD, USA. Electronic address: aa135m@nih.gov.
authors.forename: Ann L
authors.initials: AL
authors.lastname: Anderson
authors.affiliation: National Institutes of Health, National Institute on Drug Abuse, Division of Pharmacotherapies and Medical Consequences, Bethesda, MD, USA.
authors.forename: Shou-Hua
authors.initials: SH
authors.lastname: Li
authors.affiliation: Medivation, Inc., San Francisco, CA, USA.
authors.forename: Denka
authors.initials: D
authors.lastname: Markova
authors.affiliation: Stanford Center for Sleep Sciences and Medicine, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, USA.
authors.forename: Tyson H
authors.initials: TH
authors.lastname: Holmes
authors.affiliation: National Institutes of Health, National Institute on Drug Abuse, Division of Pharmacotherapies and Medical Consequences, Bethesda, MD, USA.
authors.forename: Nora
authors.initials: N
authors.lastname: Chiang
authors.affiliation: National Institutes of Health, National Institute on Drug Abuse, Division of Pharmacotherapies and Medical Consequences, Bethesda, MD, USA.
authors.forename: Roberta
authors.initials: R
authors.lastname: Kahn
authors.affiliation: University of Kansas, Kansas City, KS, USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Campbell
authors.affiliation: Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA.
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Dickerson
authors.affiliation: St. Luke's Hospital, San Francisco, CA, USA.
authors.forename: Gantt P
authors.initials: GP
authors.lastname: Galloway
authors.affiliation: University of Hawaii, Honolulu, HI, USA.
authors.forename: William
authors.initials: W
authors.lastname: Haning
authors.affiliation: UTX, Health Science Center, San Antonio, TX, USA.
authors.forename: John D
authors.initials: JD
authors.lastname: Roache
authors.affiliation: VA Health Care System, Salt Lake City, UT, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Stock
authors.affiliation: Nat'l Rehabilitation Center, Abu Dhabi, United Arab Emirates.
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Elkashef
mesh_terms: D000328:Adult; D019969:Amphetamine-Related Disorders / Q000188:drug therapy* / Q000523:psychology / Q000628:therapy; D016642:Bupropion / Q000627:therapeutic use*; D018765:Dopamine Uptake Inhibitors / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008694:Methamphetamine / Q000652:urine; D011615:Psychotherapy, Group; D016896:Treatment Outcome
chemical_list: D018765:Dopamine Uptake Inhibitors; D016642:Bupropion; D008694:Methamphetamine
keywords: Bupropion; Drug therapy; Medication adherence; Methamphetamine; Patient acuity; Substance-related disorders
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