Naltrexone Plus Bupropion Reduces Cigarette Smoking in Individuals With Methamphetamine Use Disorder: A Secondary Analysis From the CTN ADAPT-2 Trial

Authors

Joy M Schmitz
Angela L Stotts
Jin H Yoon
Thomas F Northrup
Yolanda R Villarreal
Luba Yammine
Michael F Weaver
Thomas Carmody
Steven Shoptaw
Madhukar H Trivedi

Publication Date

8-1-2023

Journal

Journal of Substance Use and Addiction Treatment

Abstract

Introduction: Methamphetamine (MA) use is marked by high rates of comorbid tobacco smoking, which is associated with more severe drug use and worse clinical outcomes compared to single use of either drug. Research has shown the combination of naltrexone plus oral bupropion (NTX-BUP) improves smoking cessation outcomes in non-MA-using populations. In the Accelerated Development of Additive Pharmacotherapy Treatment (ADAPT-2) study, NTX-BUP successfully reduced MA use. Our aim in this secondary data analysis was to examine changes in cigarette smoking among the subgroup of participants reporting comorbid tobacco use in the ADAPT-2 trial.

Methods: The multi-site ADAPT-2 study used a randomized, double blind, sequential parallel comparison design to evaluate treatment with extended-release injectable NTX (380 mg every 3 weeks) combined with once-daily oral extended-release BUP (450 mg/day) vs matching injectable and oral placebo in outpatients with moderate or severe MA use disorder. The study assessed smoking outcomes, based on self-reported timeline followback (TLFB) data, twice/week for 13 weeks.

Results: Of the 403 participants in the ADAPT-2 trial, 290 reported being current cigarette smokers (71.9 %). The study found significant differences (p's < 0.0001) for each smoking outcome indicating greater change in the proportion of nonsmoking days, number of cigarettes smoked per week, and consecutive nonsmoking days, all favoring the group receiving NTX-BUP versus placebo.

Conclusions: NTX-BUP was associated with significant reductions in self-reported cigarette smoking in the context of concurrent treatment for MA use disorder. These off-target medication effects warrant prospective investigation using biochemically confirmed measures of smoking abstinence. The development of NTX-BUP as a co-addiction treatment strategy has a potential for high public health impact.

Keywords

Humans, Naltrexone, Bupropion, Cigarette Smoking, Narcotic Antagonists, Methamphetamine, Prospective Studies, Methamphetamine, Tobacco use, Naltrexone, Bupropion, ADAPT-2 trial, Co-occurring substances, Combination pharmacotherapy

DOI

10.1016/j.josat.2023.208987

PMID

36822269

PMCID

PMC11008704

PubMedCentral® Posted Date

8-1-2024

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes