Pharmacological management of acute methamphetamine withdrawal

People who cease regular methamphetamine (MA) use can experience a distinct withdrawal syndrome, that when untreated forms a significant barrier to people meeting their treatment goals. There are no effective pharmacological treatments for MA withdrawal. The aim of this thesis is to improve our understanding of MA withdrawal treatment, to test the safety and feasibility of a potential new pharmacological treatment for MA withdrawal and to improve the understanding of sleep outcome measurement and participant experiences in a clinical trial. This thesis is made up of five chapters exploring these aims: a systematic review and meta-analysis to determine the quality of evidence for previously trialled pharmacotherapies; a protocol for a pilot clinical trial of lisdexamfetamine for the treatment of acute MA withdrawal; an open-label clinical trial to determine the safety and feasibility of lisdexamfetamine for the treatment of acute MA withdrawal; a feasibility and utility study of a combination subjective and objective sleep measurement technique during withdrawal and; qualitative interviews to examine the participant experience of a clinical trial. This thesis found that not only was there no effective pharmacological treatment for MA withdrawal, but due to methodological issues we cannot rule out any previously studied medications. Lisdexamfetamine was safe and feasible for the treatment of acute MA withdrawal in an inpatient setting, and participants experienced a reduction in withdrawal symptoms and cravings through the intervention. A combination of actigraphy and daily sleep diaries was feasible for use in this context, generated high-quality sleep data, was acceptable to participants and did not impact therapeutic intervention. Participants suggested that strengthening participant agency, trust in service providers, feelings of safety and open communication between researchers, service providers and participants in future trial design may promote subsequent decisions to remain enrolled in trials. The findings from this thesis will aid future research into pharmacological treatments of MA withdrawal, supporting a randomised controlled trial to test the efficacy of lisdexamfetamine for the treatment of MA withdrawal. Further, results of this thesis will inform co-design processes and drive the incorporation of sleep assessment in future trials, improving the care that people undergoing MA withdrawal experience.

Grantor dc:publisher

UNSW, Sydney

Year dc:date

2024

Author dc:creator

• Acheson, Liam ; https://orcid.org/0000-0002-2343-5504

• methamphetamine
• clinical trial
• treatment
• substance use
• qualitative
• sleep
• anzsrc-for: 3202 Clinical sciences
• anzsrc-for: 329999 Other biomedical and clinical sciences not elsewhere classified
• anzsrc-for: 320221 Psychiatry (incl. psychotherapy)

Statement dc:rights

• open access
• CC BY 4.0
• free_to_read

Licence

• https://purl.org/coar/access_right/c_abf2
• https://creativecommons.org/licenses/by/4.0/

Language dc:language

en

Identifier

https://doi.org/10.26190/unsworks/30182

OAI identifier oai:identifier

oai:unsworks.library.unsw.edu.au:1959.4/102263