National Amphetamine-Type Stimulant Strategy Background Paper

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of ATS use may be less responsive. Some evidence exists to suggest this differential
responsiveness (e.g., Donovan & Nunes, 1998). A final concern is the combined effect
of using SSRIs (selective serotonin reuptake inhibitors) with people who are using ATS.
Research suggests that the SSRI fluoxetine may potentiate acute toxic effects of MDMA in
susceptible individuals (e.g., Hegadoren et al., 1999) and thus, more research is needed
to investigate the interaction of SSRIs and MDMA and its potential contribution to serotonin
toxicity. This all suggests the need for more research, particularly research identifying
subgroups with whom antidepressants may be indicated and contraindicated.
Shearer and Gowing (2004) have observed that in fact the evidence for pharmacotherapies
is generally limited, except for managing co-existing dependence on other drugs (such as
using evidence-based pharmacotherapies for opioid dependence) or managing co-existing
conditions (such as attention deficit hyperactivity disorder (ADHD) or affective disorders).
These researchers provide a succinct and useful summary of the pharmacotherapy
research:
…with the exception of pharmacotherapies targeted towards accurately and appropriately
diagnosed comorbid conditions such as affective disorders, psychotic disorders, attention
deficit disorders and opioid dependence, the use of pharmacotherapies for the promotion
or maintenance of psychostimulant abstinence or the management of psychostimulant
withdrawal continues to be experimental. The inherent risks of pharmacotherapy may
suggest that the use of pharmacotherapeutic agents should be limited to users diagnosed
with more severe dependence who experience the greatest burden of psychostimulantrelated
harms (Shearer & Gowing, 2004, p.130).
The potential role of pharmacotherapy in treatment for ATS abuse was repeatedly
raised during the consultation process. There were many appeals for more research into
substitution therapy in recognition that, at present, there is no strong evidence base for
pharmacotherapy for ATS related problems. Furthermore, it was suggested that substitution
therapy could make treatment more appealing, at least to some ATS users. However, the
view that substitution therapy was problematic and only served to replace one form of
dependence with another was also expressed. Thus, it was argued, use of substitution
in the long term needs to be carefully considered on a case-by-case basis.
It was also recognised that pharmacotherapy may be more beneficial when used in
conjunction with other forms of treatment, such as psychosocial interventions. In particular,
the initial role of pharmacotherapy in crisis management was acknowledged, but that
there was a need for this to be followed by helping clients to cope with the underlying
psychosocial issues. Thus, the need for better relations and collaboration between services
and treatment options was again emphasised.
Finally, pharmacotherapies were discussed in relation to the management of psychotic
presentations, detoxification and withdrawal. In relation to the former, it was suggested that
there was a need for improved protocols due to the risks associated with administering
antipsychotics to those with methamphetamine-induced psychosis, as opposed to psychosis
unrelated to drug use. The appropriateness of sedation regimes for those in heightened
arousal due to a combination of amphetamine use and alcohol consumption was also
questioned due to pre-existing levels of intoxication. Medically-assisted detoxification