SAN DIEGO—Off-label medication options are sometimes the only option for prescribers treating stimulant use disorders. This remains the case  at a time when stimulant use and overdose rates are on the rise. Larissa Mooney, MD, UCLA Associate Clinical Professor of Psychiatry, provided an overview of medication treatment options that are promising, but unproven.

At Psych Congress 2019, Dr. Mooney, who also directs the UCLA Addition Psychiatry Clinic, admits that most of the findings are not particularly robust. The limited options and lack of novel treatments even close to FDA approval leave only behavioral therapies for cocaine or methamphetamine use disorder, as well as reward-based “contingency management” approaches.

While treatment options can be discouraging for both physicians and patients, there is very promising news. Despite the brain dysfunction in the dopamine and glutamate systems caused by chronic methamphetamine use, recovery of brain function is apparent within 9 months to 2 years.

Dr. Mooney described some of the similarities between cocaine and methamphetamine, such as their overlapping mechanisms of action, and key differences that contribute to varying use patterns, such as methamphetamine’s much longer duration of action.

Dr. Mooney discusses her approach when often faced with off-label medication options that have minimal efficacy; she says she is guided in her practice by considering any comorbid conditions that also may be affecting the patient. For example, if the patient also exhibits symptoms of anxiety or depression, she will select a medication that also is effective for addressing those symptoms.

Bupropion and topiramate are among the medications that have shown promising results for both cocaine and methamphetamine addiction.