Medication treatment of ICE use disorders – an update

Treatment of ICE Use Disorders 

ICE = crystal methamphetamine

Crystal chunks or ice or glass looking substance derived from pseudoephedrine

Most commonly used illicit drug after cannabis

Smoked, snorted or IV use

Gives euphoria, ‘rush’, confidence, loss of inhibitions – risk taking behaviour

Adverse effects – paranoid thinking, anxiety, depressed mood, insomnia, hyperthermia, teeth disease, arrhythmias, stroke, Parkinson’s disease risk

Both abuse and dependence syndromes 

Treatment 

Behavioural and psychological approaches – contingency management, cognitive behavioural therapy, motivational enhancement strategies

No approved medications for ICE use disorders

Possible pharmacotherapy approaches 

To ease symptoms of withdrawal – tapered treatment

Dexamphetamine or methylphenidate or modafinil stimulants

Bupropion (releases monoamines – dopamine, serotonin, noradrenalin) 

Substitute therapies

Dexamphetamine, methylphenidate, or modafinil 

Prevent relapse

Naltrexone

Immunotherapy

Anti-methamphetamine monoclonal antibodies (AMMA) – bind methamphetamine in peripheral blood – role in overdose and relapse prevention

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