The co-occurrence of Opioid Use Disorder (OUD) and Methamphetamine Use Disorder (MUD) is a serious public health concern. Opioid addiction has well-established medical interventions that improve recovery rates and reduce the risk of death. This success has led to questions about whether these treatments can be applied to other substance use disorders, such as methamphetamine addiction. This article addresses whether Suboxone is applicable to MUD treatment, clarifying the differences between the conditions and detailing the current standard of care for methamphetamine addiction.
Suboxone Treatment Focus
Suboxone is a widely recognized brand name for a combination medication consisting of buprenorphine and naloxone, which is a form of Medication Assisted Treatment (MAT). This medication is specifically indicated and approved by the Food and Drug Administration (FDA) for the treatment of Opioid Use Disorder (OUD). Buprenorphine is a partial opioid agonist that attaches to the brain’s opioid receptors to reduce drug cravings and withdrawal symptoms without producing the full euphoric effects of other opioids. The naloxone component is an opioid antagonist included to discourage the misuse of the medication by injection.
Suboxone is not approved by the FDA for the treatment of Methamphetamine Use Disorder (MUD) or any other stimulant use disorder. The medication’s mechanism of action targets the neurobiology of opioid addiction, which is fundamentally different from how methamphetamine affects the brain. Individuals with co-occurring OUD and MUD may be prescribed Suboxone, but its purpose is solely to manage the opioid dependence. Using a medication designed for one condition to treat an entirely different one is generally ineffective.
Pharmacological Differences Between Opioid and Stimulant Addiction
The difference in Suboxone’s effectiveness is rooted in the distinct pharmacological pathways that opioids and stimulants utilize in the brain. Opioid dependence involves the mu-opioid receptor system, a network of proteins that regulate pain, stress, and reward. Opioids like heroin or fentanyl bind to these receptors, causing an intense release of pleasure-inducing chemicals. Buprenorphine works by binding to these same mu-opioid receptors with high affinity but low activity, acting as a “partial agonist” to stabilize the system and block other opioids from attaching.
Methamphetamine is a powerful central nervous system stimulant that primarily affects the monoamine neurotransmitter systems. It causes a massive surge of dopamine and norepinephrine into the synapse, which are chemical messengers responsible for euphoria, energy, and alertness. Methamphetamine achieves this by stimulating the release of these neurotransmitters and blocking their reuptake back into the nerve cell. Since MUD does not directly involve the mu-opioid receptor system, a medication like Suboxone has no direct mechanism to treat it.
Proven Treatments for Methamphetamine Use Disorder
Since opioid-focused medications like Suboxone are not effective treatments for MUD, the standard of care relies heavily on behavioral therapies. Currently, no medications are specifically approved by the FDA for MUD treatment. The most effective interventions are psychosocial and behavioral, helping individuals change thought patterns and behaviors related to drug use.
Contingency Management (CM) is one of the most effective behavioral treatments for MUD, which uses motivational incentives to encourage abstinence. Patients receive tangible rewards, such as vouchers or prizes, for providing drug-negative urine samples, directly reinforcing the goal of sobriety. Cognitive Behavioral Therapy (CBT) is also a foundational component of MUD treatment, helping patients identify and modify the thoughts, feelings, and situations that lead to drug use.
While no medication has received full FDA approval for MUD, research into pharmacological agents is ongoing. A combination of extended-release naltrexone, an opioid antagonist, and oral bupropion, an antidepressant, has shown promising results in clinical trials. This combination reduces methamphetamine use and cravings in people with moderate to severe MUD. This dual-medication approach targets different aspects of the reward system and represents a significant area for future advancements in MUD pharmacotherapy.