At an alarming pace, Meth is gaining ground on opioids as an addictive substance. Solutions could lie in some of Ohio’s recent efforts. Michael Howcroft, Pharmacy Consultant, Beat Addiction Recovery.
As a practicing pharmacist I have been witness to the rise in the use of analgesic opioids such as Oxycodone, anxiolytics like Xanax, and Methamphetamine – at times purchased right in front of my pharmacy parking lot. I have practiced in retail, hospital, oncology, and home infusion pharmacy. I also have been a director of pharmacy for Blue Cross Blue Shield of Ohio, Managed Care Pharmacy and Ohio Medicaid. I have had the privilege of directly managing the pharmacy benefits, and indirectly managing the medical benefits. Managing the legal and illicit drugs in Ohio has been challenging.
At Medicaid, I served at the pleasure of the governor of the state of Ohio, on the Governor’s Cabinet Opioid Action Team or GCOAT. This was a multidisciplinary team (including coroners, dentists, veterinarians among other professionals) whose charter was to identify illicit substance utilization, form ideas to prevent drug-related deaths, and to produce guidelines for appropriate prescribing of opioids. During these discussions it became very apparent that prescribing of opioids was a problem. Medicaid was able to produce internal reports of patients being admitted to the hospital through the emergency room for overdoses. Patients, when drug toxicity screens were reviewed, were positive for opioids, marijuana, heroin, methamphetamine, barbiturates and benzodiazepines and alcohol, which when combined, can and often did lead to death.
Opioids and alcohol have dominated the news, but there is another drug, methamphetamine, that has been lurking in the background because of its inherent pharmacological properties and its effect on attention, cognition, emotions (such as euphoria), appetite, and health (dental); It has become an epidemic.
A lot is known about methamphetamine. Methamphetamine is in a “therapeutic” class of drugs called Amphetamines. Amphetamines are stimulants and increase the amount of “dopamine” in the brain (the pleasure center). Amphetamines are also in what is called Class II Scheduled Drug, meaning it has a high potential for abuse and comes with prescribing limits. This class of drugs became an important tool for physicians to use for weight loss (appetite suppressant), as an antidepressant, for fatigue and for ADHD (study aid). The amphetamine class of drugs have been around for years beginning in the 1920s and was first used by the military to keep soldiers awake. Common names are Dexedrine, Ritalin, and Adderall.
Methamphetamine is from the “parent compound Amphetamine” and is a highly addictive stimulant that affects the central nervous and somatic systems. It differs from amphetamines in that it is more potent, lasts longer, and is harmful to the central nervous system. Data from a 2017 National Survey, conducted by the National Institute on Drug Abuse and Health (NSDUH), over 14.7 million people (5.4% of the United States population) have tried methamphetamine at least once. NIDAs National Drug Early Warning System (NDEWS) stated that overdose deaths from the category of drugs that include methamphetamine increased by 7.5 times between 2007 and 2017 nationwide. About 15% of all drug overdose deaths involved methamphetamines, and 50% of those deaths also involved opioids. In 2020, 2.5 million Americans had used methamphetamine in the past year from diagnoses and surveys, but the actual number is likely higher than that.
There is a bill in the 117th Congress (#2051) that designates methamphetamine as an EMERGING drug threat. It also directs The Office of National Drug Control Policy to implement a methamphetamine response plan.
Drugabuse.gov also provides a very good resource of current methamphetamine use in the United States.
There also might be a link to Covid-19 in that the federal government placed a lot of restrictions on people, which may have made addicts feel even more isolated, leaving them to turn to methamphetamine to satisfy their feelings of isolation.
In my opinion, while there is a lot of known information on methamphetamine, it seems that the federal and state governments, as well as health plans, are not focused enough on the methamphetamine epidemic.
Are there remedies to assist methamphetamine addicts with recovery, and to keep them in recovery?
The answer is yes. There are clinics that offer FDA-approved medication-assisted treatments, behavioral health programs, and addiction treatment programs (opioid, methamphetamine, alcohol). The most effective treatments for methamphetamine addiction are behavioral therapies. Contingency management interventions, which provide tangible incentives in exchange for engaging in treatment and maintaining abstinence, have also been shown to be effective. Motivational Incentives for Enhancing Drug Abuse Recovery (MIEDAR), an incentive-based method for promoting cocaine and methamphetamine abstinence, has demonstrated efficacy among methamphetamine misusers through NIDA’s National Drug Abuse Clinical Trials Network.
So while there are programs and medication-assisted treatments available, another problem is that this can be too much for an addict to handle. While the methamphetamine addict is worrying where the next “hit” comes from, they also worry about the next meal, and where they can rest.
Addiction treatment programs and the FDA need to collaborate as a multidisciplinary team, just like Ohio did, to ATTACK the addiction problem. New treatment modalities, new therapeutics, and new dosage forms for existing therapeutics should be made available when sufficient efficacy and safety data are provided, so that the FDA can provide “provisional” approval status to begin to get these methamphetamine addicts the help they need.
About Michael Howcroft, Pharmacy Consultant, Beat Addiction Recovery
Mr. Howcroft’s credentials include a B.S. in biology, an M.Sc. in biology, and is a registered pharmacist in the state of Ohio. Mr. Howcroft’s education includes Xavier University in Cincinnati, the University of Cincinnati and a fellow of the Kellogg School of Management. Mr. Howcroft was a co-founder of one of the first Pharmacy Benefit Management Companies, currently known as Anthem. Mr. Howcroft’s experience is in drug formulary management, preferred drug list management, rebate contracting, outcomes and value-based contracts, benefit analysis and design, disease state management, drug utilization review management, data analysis, experience in writing legislative administrative code policies, an acute understanding of medical and pharmacy coding, management of the pharmacy and therapeutics committee and drug utilization review board. Mr. Howcroft also served as secretary to the Chief Medical Officer in the development and implementation of the Ohio Governor’s Cabinet Opiate Action Team (GCOAT) which developed policies in Ohio for Opioid prescribing guidelines. Mr. Howcroft has worked with Governor Mike DeWine’s office to develop provider education programs on opioids.
About BioCorRx
BioCorRx® is a leading-edge healthcare solutions company focused on improving the lives of those struggling with alcohol, opioid, and other addictive disorders. Designed to address alcoholism and certain opioid addictions, the BioCorRx® Recovery Program is used by independent treatment centers or physicians in the United States. The program consists of BioCorRx’s proprietary cognitive behavioral therapy (CBT) program and peer recovery support mobile application and may include the use of certain medications typically used for the treatment of substance use disorder (SUD). Which medication used, if any, is at the sole discretion of the treating physician in consultation with their patient. The most common medication used in the program is naltrexone in various forms (oral, injectable, implantable pellet).
