DARU Journal of Pharmaceutical Sciences | 2019
An epidemic amphetamine problem: commentary on treatment of amphetamine abuse/use disorder
Abstract
Dear Editor-in-Chief In Khoramizadeh and colleagues’ paper which has been recently published in Daru Journal of Pharmaceutical Sciences [1], a new effort was made to systematically review the positive outcomes of psychiatric medications for treating amphetamines in Iran. The treatment of amphetamine abuse/use disorder remains a health priority which has led to this message that Iranian health policy makers have frequently highlighted the necessity of delivering effective interventions [2]. The authors conducted a systematic review to investigate how a health priority has been addressed in the country level context. Amphetamine is a highly addictive psycho-stimulant drug which its chronic use is associated with cardiovascular diseases, frequent hospitalization, intoxication and death [3]. The continued use of amphetamine leads to poor psychological well-being and social dysfunction which can prolong for months [4]. The long-term psychiatric effects of amphetamine abuse/use disorder are well-studied and include psychosis, depression, aggression and suicidality [3, 4]. This issue is primarily accompanied with poor motivation to change, an urgent need for treatment and long-term rehabilitation programs [3]. Amphetamines remain a new health concern while opiates are the traditional drugs of use [2, 5]. Amphetamine abuse/use disorder is associated with poor treatment outcomes, recurrent craving and consistent relapse in patients [2, 5]. This issue is accompanied with a high rate of admission of amphetamine patients to emergency departments of hospitals [5]. It therefore represents a major public health and social dilemma which needs treatment services. In recent years, some psychiatric medications have been evaluated and prescribed for treating amphetamine use/abuse disorder in Iran [1]. Furthermore, cost-effective and feasible behavioral interventions such as brief cognitive-behavioural therapy (BCBT) have been evaluated to treat amphetamine abuse/use disorder [1]. A combination of prescribing psychiatric medications with using behavioral interventions have been found to be effective in treating amphetamine use/ abuse disorder [1]. However, to date, before the mentioned systematic review, there was no one to show which aspects of amphetamine abuse/use disorder had been treated in the Persian context. Khoramizadeh and colleagues’ review paper has specifically shown what medications are effective for what sign and symptoms of amphetamine abuse/use disorder. The outcomes of their study indicate that risperidone and aripiprazole reduced positive and negative psychotic symptoms, respectively. Topiramate and buprenorphine reduced severity of addiction and craving, respectively while haloperidol, riluzole, and methylphenidate reduced psychosis, depressed mood, withdrawal, and craving, respectively. However, the review is not limited to pharmacotherapy and also highlighted the latest behavioural interventions (i.e. BCBT). The review indicated that BCBT led to abstinence from amphetamines and improved health outcomes and social functioning [1]. These key findings are important because they can work as a potential guide for clinicians in prescribing medications and using behavioural interventions in to treat amphetamine abuse/use disorder. In our view, the study deserves further discussion because it shows that some signs and symptoms of amphetamine abuse/use disorder can be treated with the use of psychiatric medications. Furthermore, the positive and long-term effects of BCBT on amphetamine patients are considerable. This issue indicates that if we apply BCBT alone or combined with psychiatric medications for amphetamine patients, we can * Saeed Nateghi [email protected]