Does anyone know of any literature/research articles regarding the substitute prescribing of stimulants?

Did a quick medline search on amphtamine + substituion and cocaine + substitution. The first search produced 3 relevant studies: thse last one is a meta analysis - basically says: 'lack of research evidence, what there is is not promising'.

Substitution therapy for amphetamine users.
Source
Drug and alcohol review {Drug-Alcohol-Rev} 2002 Jun, VOL: 21 (2), P: 179-85, Refs: 49, ISSN: 0959-5236.
Author(s)
Shearer-James, Sherman-John, Wodak-Alex, van-Beek-Ingrid.

Dexamphetamine substitution in the treatment of amphetamine abuse: An initial investigation.
Author(s)
White-R.

Author affiliation
R. White, Dept. of Psychiat. and Behav. Sci., University College Medical School, Highgate Hill, London N19 5NF, United Kingdom.
Source
Addiction {ADDICTION}, 2000, Vol/Iss/Pg. 95/2 (229-238), ISSN: 0965-2140.

Title
Drug replacement treatments: Is amphetamine substitution a horse of a different colour?
Source
Drug & Alcohol Review, 1995, vol. 14, no. 4, p. 389-394, United Kingdom: Taylor & Francis, http:\\www.tandf.co.uk, ISSN: 0959-5236 (Print), ISSN: 1465-3362 (Electronic).
Author(s)
Mattick-Richard-P; Darke-Shane.

cocaine search only produced llots of biochemistry and horrible animal studies!

NB this is not a proper literature search, you could ask your local postgrad librarian to do one

susi

Here's one too, from Pubmed (which anyone can access by the way through the excellent National Electronic Library for Health at http://www.nelh.nhs.uk/):

Addict Behav. 2004 Sep;29(7):1439-64.

Agonist-like, replacement pharmacotherapy for stimulant abuse and dependence.

Grabowski J, Shearer J, Merrill J, Negus SS.

Substance Abuse Research Center, Department of Psychiatry and Behavioural Sciences, University of Texas-Health Science Center at Houston, 1300 Moursund Street, Houston, TX 77030, USA. john.grabowski@uth.tmc.edu

Stimulant abuse and dependence are disproportionately problematic due to the combination of legal and social issues added to the serious behavioural and biological features of the disorders. These problems are compounded by adverse consequences for families and society. Illegality and stigma multiply the consequences of use and difficulties in providing treatment. Specific behavioural interventions have been demonstrated as useful in treatment of substance use disorders (SUDs). Medications also have an important role in treatment. Effective agonist and antagonist pharmacotherapies as well as symptomatic treatments exist for opioid and nicotine dependence. Neither agonists nor antagonists have been approved as uniquely effective for treatment of stimulant abuse or dependence. Still, promising results are emerging for an agonist-like or 'replacement' strategy paralleling that for nicotine and opioid dependence. Supporting data have emerged from both preclinical and clinical research environments. There are scientific, clinical, social, and legal impediments to application of an agonist-like approach to stimulant abuse and dependence. Some resemble past and current concerns about opioid replacement. Others are unique to the stimulant agents, effects, and clinical features. Here, the authors consider (1) agonist and antagonist pharmacotherapy strategies; (2) preclinical research, including methodological approaches, opioid and nicotine replacement, and agonists for stimulant dependence; (3) clinical reports with stimulant medications in cocaine dependence, and the amphetamine replacement strategy for amphetamine dependence; (4) application of agonist-like/replacement strategies, including clinical requirements and risks; and (5) directions for research. Copyright 2004 Elsevier Ltd.

Simon

1. Amphetamine Misuse: International Perspectives on Current Trends
~Hilary Klee
Taylor & Francis
Paperback - April 8, 1997
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I have this book, available rapidly from amazon, as you can see.I've just taken it down from my shelf to remind myself. Hilary klee was at the time in Manchester(UK), according to the book. It was written in 1997. i do quite like her own chapter, describing the "typology of amphetamine users" although I can't see any mention of the self medicating ADHD people i have seen, and only a bit about the underlying grief and history of abuse that is so freqently hidden behind the longstanding amphetamine users . The author of one chapter, Judith Myles says " It is with regret that..in 1995, interventions for stimulent users are little better researched and developed than in 1968"

skipping through the book again, in a chapter on methamphetamine in USA, there are my two subgroups of ADHD and history of physical and sexual abuse.

Here we are, 10 years later.

I find it a difficult area, and am much much much more resistant to taking people on to dexedrine scripts than onto opiate replacement scripts.

[This message was edited by judith yates on 18 November 2004 at 08:17 PM.]

So do others here see much amphetamine in use?

I can't say I have seen an increase in amphetamine use. However I have heard a whisper that it may be useful in treating patients with a crack cocaine habit.

yes there was one article I came across which was just a pilot study:
Pilot Randomised double blind placebo controlled study of dexamphetamine for cocaine dependence, Shearer, J (him again!) et al, Addiction 98: 1137-1141 it showed in favvour of the treatment group but not statistically significant, and concluded definitive evaluation feasible and warranted. Can send you whole paper if interested

There is a big thread on other treatments for cocaine dependence elsewhere on the site.

In answer to your question Judith, we have started to see more amphet users of late, I think it's the new criminal justice programmes pulling in clients we didn't used to see. but maybe there's more of it about? I haven't had good experiences of treating them and so I currently don't - your experiences sound similar.

susi

I am sorry i have nothing to add here and will be skipping to the cocaine thread.
While i am here tho could someone explain what a stimulant user would do then?
I personally feel/know that Acupuncture is helpful but what if a s/u only 'trusts' medication/Drugs esp at beginning of Recovery maybe.
Tony B