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Review
. 2023 Apr;118(4):750-762.
doi: 10.1111/add.16093. Epub 2022 Dec 12.

Clinical management of psychostimulant withdrawal: review of the evidence

Michael J Li  1 , Steven J Shoptaw  1   2
Affiliations
Review

Clinical management of psychostimulant withdrawal: review of the evidence

Michael J Li et al. Addiction. 2023 Apr.

Abstract

It is estimated that a majority of people who use psychostimulants, particularly methamphetamine (MA) and cocaine, experience withdrawal upon abstinence from sustained use. This review of clinical research reports the evidence regarding biomedical and behavioral treatments for psychostimulant withdrawal symptoms. It provides a framework for clinicians and scientists to increase impact on attenuating MA and cocaine withdrawal during initial and sustained abstinence. Articles reviewed included reports of controlled clinical trials (randomized or non-randomized) reporting at least one withdrawal symptom among the outcomes or specifically studying patients in withdrawal. Potential efficacy for MA withdrawal is noted for a few medications (mirtazapine, naltrexone, bupropion) and repetitive transcranial magnetic stimulation during acute (first week), early protracted (weeks 2-4) and late protracted (> 4 weeks) withdrawal phases. Topiramate shows mixed evidence of efficacy for cocaine withdrawal. In general, there is inconsistent signal for biomedical and behavioral treatments on MA and cocaine withdrawal.

Keywords: Amphetamine; cocaine; methamphetamine; review; treatment; withdrawal.

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Conflict of interest statement

Conflict of Interest:

We declare no conflicts of interests.

Figures

Figure 1.
Figure 1.
Summary of stimulant withdrawal symptoms across different phases (with timeframe following abstinence).
See this image and copyright information in PMC

References

    1. United Nations Office on Drugs and Crime. Drug Market Trends: Cocaine, Amphetamine-type Stimulants, New Psychoactive Substances. World Drug Report; [Internet]. 2022. Available from: https://www.unodc.org/unodc/en/data-and-analysis/world-drug-report-2022.....
    1. Farrell M, Martin NK, Stockings E, Bórquez A, Cepeda JA, Degenhardt L, et al. Responding to global stimulant use: challenges and opportunities. The Lancet. 2019;394(10209):1652–67. - PMC - PubMed
    1. Han B, Compton WM, Jones CM, Einstein EB, Volkow ND. Methamphetamine Use, Methamphetamine Use Disorder, and Associated Overdose Deaths Among US Adults. JAMA Psychiatry. 2021;78(12):1329–42. - PMC - PubMed
    1. Han B, Cotto J, Etz K, Einstein EB, Compton WM, Volkow ND. Methamphetamine Overdose Deaths in the US by Sex and Race and Ethnicity. JAMA Psychiatry. 2021;78(5):564–7. - PMC - PubMed
    1. Man N, Chrzanowska A, Price O, Bruno R, Dietze PM, Sisson SA, et al. Trends in cocaine use, markets and harms in Australia, 2003–2019. Drug and Alcohol Review. 2021;40(6):946–56. - PubMed

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