Amfetamine and methamphetamine use disorder

Amfetamine and methamphetamine use disorders involve compulsive substance use despite negative consequences.

Poly-substance use, for example with opioids, is an increasing problem, and increases mortality.

Psychosocial interventions such as contingency management, cognitive behavioural therapy (CBT), motivational interviewing, Matrix model, and community reinforcement approach are the mainstays of treatment; no medication has yet proven effective.

Effective management strategies incorporate a degree of long-term continuing care in addition to acute management of exacerbations.

Evaluation and management of co-occurring psychiatric conditions is essential.

Not all people with amfetamine/methamphetamine use disorder are actively seeking treatment; harm reduction strategies are especially important for this group.

Amfetamine and methamphetamine are non-catecholamine sympathomimetic amines that may be taken by various routes including inhalation, intravenous, intramuscular, or transmucosal (oral/nasal). They have a number of therapeutic uses including for the treatment of attention deficit hyperactivity disorder (ADHD) in children and adults, for narcolepsy, and occasionally as a short-term treatment for obesity.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022. Prescribed doses of amfetamine and methamphetamine are typically much lower than those taken in misuse.[2]Kish SJ. Pharmacologic mechanisms of crystal meth. CMAJ. 2008 Jun 17;178(13):1679-82. https://www.cmaj.ca/content/178/13/1679 http://www.ncbi.nlm.nih.gov/pubmed/18559805?tool=bestpractice.com Prescribed stimulants may be diverted into the illegal market, and methamphetamine is often manufactured illicitly. Amfetamine and methamphetamine are both highly addictive stimulants, which affect the central nervous system in similar ways; methamphetamine differs from amfetamine in that, at comparable doses, greater amounts of drug get into the brain, resulting in increased potency.[3]Panenka WJ, Procyshyn RM, Lecomte T, et al. Methamphetamine use: a comprehensive review of molecular, preclinical and clinical findings. Drug Alcohol Depend. 2013 May 1;129(3):167-79. http://www.ncbi.nlm.nih.gov/pubmed/23273775?tool=bestpractice.com Methamphetamine also has longer-lasting and more severe adverse effects on the central nervous system than amfetamine.[4]Moszczynska A. Neurobiology and clinical manifestations of methamphetamine neurotoxicity. Psychiatr Times. 2016 Sep;33(9):16-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6135110 http://www.ncbi.nlm.nih.gov/pubmed/30220787?tool=bestpractice.com This results in a higher potential for widespread misuse for methamphetamine compared to amfetamine.[5]National Institute on Drug Abuse. Methamphetamine research report: what is methamphetamine? Oct 2019 [internet publication]. https://nida.nih.gov/publications/research-reports/methamphetamine/what-methamphetamine

Amfetamine and methamphetamine use disorders involve the recreational use of these substances (other than for unapproved medical indication) and are defined by a pattern of substance use leading to clinically significant impairment or distress, defined by the presence of at least 2 of 11 symptoms during a 12-month period.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022. The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) classifies both amfetamine and methamphetamine as "amphetamine-type substances" and lists their respective use disorders under the sub-heading 'stimulant use disorders'. Stimulant use disorders may be mild, moderate, or severe depending on the number of symptoms within a 12-month period.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.

See: Amfetamine overdose.