Treatment for amphetamine dependence and abuse.

BACKGROUND: The ease of synthesis from inexpensive and readily available chemicals makes possible the wide spread of amphetamine dependence and abuse. Amphetamine use is of concern because it causes a variety of devastating health consequences, including physical and neurological disorders due to amphetamines, amphetamine-induced mental disorders, health consequences of amphetamine use and social consequences of amphetamine use.
OBJECTIVES: To search and determine risks, benefits and costs of a variety treatments for amphetamine dependence or abuse. SEARCH STRATEGY: Electronic searches of MEDLINE (1966 - December 2000), EMBASE (1980 - February 2001), CINAHL (1982 - January 2001) and Cochrane Controlled Trials Register (Cochrane Library 2000 issue 4) were undertaken. References to the articles obtained by any means were searched. SELECTION CRITERIA: All relevant randomised controlled trials (RCTs) and clinical controlled trials (CCTs) were included. Participants were people with amphetamine dependence or abuse, diagnosed by any set of criteria. Any kinds of biological and psychological treatment both alone and combined were examined. A variety of outcomes, for example, number of treatment responders, score changes, were considered. DATA COLLECTION AND ANALYSIS: Two reviewers evaluated and extracted the data independently. The dichotomous data were extracted on an intention-to-treat basis in which the dropouts were assigned as participants with the worst outcomes. The Relative Risk (RR) with the 95% confidence interval (95% CI) was used to assess the dichotomous data. The Weighted Mean Difference (WMD) with 95% CI was used to assessed the continuous data. MAIN
RESULTS: Fluoxetine, amlodipine, imipramine and desipramine have been investigated in four randomised-controlled trials. In comparison to placebo, short-term treatment of fluoxetine (40 mg/day) significantly decreased craving. In comparison to imipramine 10 mg/day, medium-term treatment of imipramine 150 mg/day significantly increased the duration of adherence to treatment. All four drugs had no benefits on a variety of outcomes, including amphetamine use. REVIEWER'S
CONCLUSIONS: The evidence about the treatment for amphetamine dependence and abuse is very limited. It shows that fluoxetine, amlodipine, imipramine and desipramine have very limited benefits for amphetamine dependence and abuse. Fluoxetine may decrease craving in short-term treatment. Imipramine may increase duration of adherence to treatment in medium-term treatment. Apart from these, no other benefits, in particular proximal benefits, can be found. This limited evidence suggests that no treatment has been demonstrated to be effective for the treatment of amphetamine dependence and abuse. Although there is a large number of people with amphetamine dependence and abuse worldwide, very few controlled trials in this issue have been conducted. As the previous treatment trials show no promising result, other treatments, both biological and psychosocial, should be further investigated. However, the results of neurotoxic studies of amphetamines are also crucial for the study designs appropriate for further treatment studies for amphetamine dependence and abuse.