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Treatment of metal dependence? Some clinicians try naltrexone: photos



Melinda McDowell sought treatment for her meth addiction. She began taking the drug naltrexone and soberly for over a year.

Andrea Dukakis / NDP News


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Andrea Dukakis / CPR News

Melinda McDowell sought treatment for her meth addiction. She started taking naltrexone and soberly for over a year.

Andrea Dukakis / CPR News

Melinda McDowell has used drugs since she was a teenager. But she didn't try meth until one fateful night in 2017 after her mother died of a stroke. She went to a neighbor's house and he had crystal meth.

"I tried it and was hooked from the first hit," McDowell says. "It was an explosion of the senses. It was the biggest peak I've ever experienced. "

Then, McDowell says, that high maximum began to become more elusive. But she continued to use the medicine frequently and this withdrawal. She went from £ 240 to £ 110. Eventually, she lost custody of her children who were placed in foster homes. McDowell began to have hallucinations.

McDowell tries many times to stop using meth, but when she gives up for a few days, she will have severe panic attacks and start to shake uncontrollably. One night she remembers lying on the floor in her bathroom, thinking that if she didn't get help, she would die.

She had heard about a woman named Nancy Beste, who recently opened the doors of a treatment center called the Recovery Road in Steamboat Springs, Colorado, near where McDowell lived. McDowell says she asked Beste for help.

Beste, who is a certified drug counselor and physician assistant, says that McDowell's call came at a random time. I just returned from a conference where I learned about research into what is called drug-assisted treatment, or MAT, for methamphetamine users. Some early studies show that naltrexone, the same drug used to treat alcohol addiction and opiates, may work for some people addicted to meth.

Beste gave McDowell a prescription for naltrexone and signed her up for individual and group therapy. McDowell said that three to four hours after she took her first pill, she felt better. After the second pill, the withdrawals dropped.

"The shaking started to go away. I didn't panic. I felt some relief," McDowell says. "I knew there was something different."

That was over a year ago. McDowell is still sober to this day.

Methamphetamine use is increasing nationally, especially in the West, and the treatment community is struggling to come up with the best ways to help.

Drug-assisted drug treatments such as methadone, buprenorphine, and naltrexone are standard care for people addicted to opioids, but there are currently no FDA-approved drugs for metal dependence. However, a number of practitioners are beginning to experiment with treating a disorder of metal use with naltrexone – along with other drugs such as the antidepressant bupropion. And researchers are also looking at naltrexone for meth, finding some promising initial results.

Dr. Keith Heinzerling, a specialist in addiction medicine at the Pacific Institute of Neuroscience in Santa Monica, California, says he prescribes off-the-label naltrexone, in combination with other drugs, for methamphetamine addiction if patients are interested in his experience. And he believes that when combined with the supervision and consultation of a doctor, this can be an effective treatment.

"I think there is a great opportunity to try naltrexone," says Heinzerling. "There is actually a fair amount of evidence that this can help. If I had a family member [addicted to meth] I would recommend trying it."

Heinzerling cites preliminary studies of naltrexone that support the notion that this may help reduce people's desire for meth. Heinzerling believes that naltrexone can have an anti-addictive effect on many drugs and potentially on other types of obsessive behavior.

But, he warns, many things are still unknown and more research is needed on drugs such as naltrexone for methamphetamine.

Psychologist Lara Ray, a professor at UCLA and head of the UCLA Laboratory Addictions Lab, has done several studies on the effectiveness of naltrexone in methamphetamine addiction.

In a study published in 2015 in Neuropsychopharmacology volunteers using methamphetamine were admitted for a four-day hospital stay. They were given either naltrexone or placebo, and on the last day, an IV infusion of meth. Subjects were asked a series of questions, including how strong their aspirations were.

"We found that naltrexone was better than placebo in reducing the desire for meth," Ray says.

A large, multifaceted study, conducted by Texas Tech University's Southwestern Medical Center, looked at the effects of Vivitrol – a longer-acting, injected version of naltrexone – combined with bupropion. The study, a randomized, controlled trial, was recently completed and researchers are awaiting results.

The Road to Recovery is a treatment center for addiction in Steamboat Springs, Colorado. It is run by Nancy Beste, who wants to help addicted people in this small mountain community.

Andrea Dukakis / NDP News


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Andrea Dukakis / CPR News

Road to Recovery is a treatment center for addiction in Steamboat Springs, Colo. It is run by Nancy Beste, who wants to help people living with dependency on this small mountain community.

Andrea Dukakis / CPR News

Other researchers have been trying to invent new compounds for the treatment of metal dependence. But Ray says there is more immediate benefit to the already available naltrexone and other drugs. She says that although the drugs are not FDA-approved for use in methamphetamine addiction, practitioners may choose to prescribe them off-label.

"The good news is that these drugs have been on the market for a while, so we know which side benefits and cost benefits," she says. "So it's possible for providers to make individual decisions for individual patient training [them] to think beyond the label. "

She adds that doctors should know that" the literature is somehow preliminary. "

Ray says that if she had a family member with the disorder, she would want theirs a treatment provider to experiment with drugs like naltrexone and vivitrol "in a van behavioral treatment. "

Beste, who also treats opioid-addicted patients, says all her patients should be consulted along with medication-assisted treatment and the goal is ultimately to reject them with these drugs. So far, Beste has tried naltrexone. with about 16 patients using meth, and the drug appears to have helped reduce the need for meth in about half of them.

Melissa McDowell of Steamboat Springs says getting out of meth is hard. But she credits naltrexone for helping to stay sober for more than a year. This is a difficult battle. McDowell recently learned that the courts have denied her efforts to regain custody of her children.

But it still goes on. McDowell does a job interview and at one point she wants to go to school so she can treat people like herself who want to get rid of meth.


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