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Pharmacopsychiatry 2017; 50(03): 96-104
DOI: 10.1055/s-0043-105500
Review
© Georg Thieme Verlag KG Stuttgart · New York

Evidence-Based Guidelines for the Pharmacologic Management of Methamphetamine Dependence, Relapse Prevention, Chronic Methamphetamine-Related, and Comorbid Psychiatric Disorders in Post-Acute Settings

Roland Härtel-Petri   *
1   Practice for Psychiatry and Psychotherapy, Luitpoldplatz 10, Bayreuth
,
Anne Krampe-Scheidler   *
2   German Agency for Quality in Medicine (ÄZQ), Berlin
,
Wolf-Dietrich Braunwarth
3   Department of Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Nuremberg, Germany
,
Ursula Havemann-Reinecke
4   University Medical Center Göttingen, Clinic for Psychiatry and Psychotherapy, Center of Nanoscale Microscopy and Molecular Physiology of the Brain (CNMPB), University of Göttingen, Göttingen
,
Peter Jeschke
5   Joint Neurology Practice, Gesundheitszentrum Silberhöhe e.V., Halle (Saale)
,
Winfried Looser
6   Department for Addictive Disorders, LVR-Hospital Dueren, Dueren
,
Stephan Mühlig
7   TU Chemnitz, Clinical Psychology and Psychotherapy, Chemnitz
,
Ingo Schäfer
8   Center for Interdisciplinary Addiction Research (ZIS), University of Hamburg; c/o Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg
,
Norbert Scherbaum
9   LVR-Hospital Essen, Department of Psychiatry and Psychotherapy, Medical Faculty, University of Duisburg-Essen, Essen
,
Lydia Bothe
10   German Agency for Quality in Medicine (ÄZQ)
,
Corinna Schaefer
10   German Agency for Quality in Medicine (ÄZQ)
,
Willem Hamdorf
11   AHG Klinik Mecklenburg, Rehna OT Parber
› Author Affiliations
Further Information

Publication History

received 09 May 2016
revised 14 February 2017

accepted 28 February 2017

Publication Date:
26 April 2017 (online)

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Abstract

The increasing abuse of the street drug crystal meth (methamphetamine) in many countries worldwide has resulted in a growing demand to treat patients who have acquired a methamphetamine-related disorder. The results of a systematic literature search which led to the consensus-based recommendations by the Working Group of the German Agency for Quality in Medicine (Ärztliches Zentrum für Qualität in der Medizin - ÄZQ) are presented. Pharmacological treatments were reviewed in 58 out of the 103 publications included. They were mainly randomized controlled trials (RCT). Despite increased research activities, none of the medications studied demonstrated a convincing and consistent effect on abstinence rates, despite some having an impact on craving and retention rates or symptom control. In addition, as yet there is no sufficient evidence available for dopamine analogue treatment (“substitution”) after the initial withdrawal-period. Methamphetamine-related, post-acute persistent or comorbid syndromes such as methamphetamine-associated psychosis (MAP), depressive syndromes, anxiety, and sleep disorders are usually treated in a symptom-oriented manner. Risks of interactions with methamphetamine have to be taken in account when prescribing medications with doubtful efficacy. Further research is warranted.

Key words

(Crystal) methamphetamine - treatment guidelines - rehabilitation - substitution - stimulant - comorbidity - dependence - review - associated psychosis - depression - induced psychosis

 1,3–9,12  for the consensus group of the S3 Guidelines “Methamphetamine-related Disorders”: http://www.crystal-meth.aezq.de


1 Because only quetiapine has been given marketing authorisation in Germany for relapse prevention in the depressive phases of bipolar disorder, the recommendation could therefore refer only to quetiapine.


 

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