THE EFFICACY OF ATOMOXETINE IN THE TREATMENT OF METHAMPHETAMINE DEPENDENCY DURING METHADONE MAINTENANCE THERAPY

Background and Aim : Background: Co-occurring methamphetamine abuse during methadone maintenance therapy (MMT) is a highly prevalent problem in Iran. There are no registered pharmacological treatments for treating methamphetamine use disorder. The present study investigates the potential efficacy of Atomoxetine for treatment of these patients.Methods : This study is a placebo-controlled, double-blind, randomized clinical trial. The participants were those who had been treated with methadone for a long time because of opioid dependence, but after a while, they were addicted to methamphetamines to reduce methadone complications. Volunteers were selected from methamphetamine abusers, who were on MMT at methadone maintenance therapy centers in Kashan, Iran. The participants were divided into two groups (Atomoxetine (40 mg/day) and placebo) with simple randomization using tables of random numbers by a trained staff who had no contact with the patients At the end, our trial sample included 86 participants: 41 from the placebo group and 45 from the treatment group We measured the craving scores with VAS (Visual Analog Scale) weekly and evaluated depression, anxiety and stress with DASS (Depression, Anxiety, Stress Scales) monthly. These measures were completed at each weekly visit with methamphetamine urine tests. Kolmogorov-smirnov test was used for evaluation of normality of the data. The demographic, clinical and psychological variables were compared between Atomoxetine and placebo groups by Chi-Square, independent t-tests. Also the repeated measure ANOVA was used for investigation of the weekly variations. Results : Atomoxetine significantly reduced methamphetamine craving (p<0.001) .Negative methamphetamine urine tests increased in drug group significantly more than placebo group (p=0.007). While at the first all of the methamphetamine urine tests were positive, after 8 weeks 56% (25/45) of the Atomoxetine group and 26% (11/41) of the placebo group had negative methamphetamine urine tests. Depression, Anxiety and Stress Scales were decreased in both groups with a greater reduction for Atomoxetine group (Depression (p=0.028), Anxiety (p=0.038), and Stress (p=0.031).Only mild side effects were observed.Conclusion : The findings of this study, while confirming the safety and clinical tolerance of Atomoxetine, show good efficacy of this medicine in suppressing METH craving and its potential effects on the treatment of methamphetamine dependence

Keywords:

Atomoxetine , maintenance , methadone , methamphetamine