According to a commentary published in the Canadian Medical Association Journal earlier in July, prescribing psychostimulants can help patients to reduce their reliance on the illegal stimulant supply. The commentary, authored by Dr. Scott MacDonald, a family physician at Providence Health Care’s Crosstown Clinic in Vancouver, and Dr. Heather Palis, a postdoctoral researcher at the University of British Columbia, suggests that broader implementation of prescribed psychostimulant medications is needed.
“It’s time to start prescribing because there’s rising use of illegal stimulants in Canada,” said Dr. MacDonald in his interview with The Globe and Mail.
So far, no medication has been approved in Canada for treating stimulant use disorder in Canada. However, according to Dr. MacDonald, prescribed psychostimulants have been used off-label for this purpose in certain parts of the country.
The authors noted that prescribed psychostimulants can be used to reduce cravings and withdrawal symptoms in individuals affected by stimulant use disorder, similar to opioid agonist treatment, which involves medications such as methadone, Suboxone or Kadian, to decrease the harms of opioid use. The commentary also highlighted a recent systematic review of 38 clinical trials which concluded that prescribed psychostimulants constituted a safe, effective intervention.
Moreover, Dr. MacDonald noted that a select group of patients treated at his clinic who used illegal stimulants, including cocaine and methamphetamine, benefited from prescribed psychostimulants. “Their cravings went down, they used less, their lives became more ordered.”
He also suggested that prescribed psychostimulants can be used together with medications for treating opioid use disorder.
However, Dr. Leslie Buckley, chief of the addictions division at the Centre for Addiction and Mental Health in Toronto, expressed concerns over prescribed stimulants increasingly making their way into the illicit drug supply. She also said it is unclear whether prescribing psychostimulants could prevent opioid toxicity deaths, while reducing the overall consumption of illegal stimulants could help, since many opioid-related overdose deaths currently occur among individuals who take illegal stimulants which contain fentanyl.