Professionals weigh responses to re-emergence of stimulants

With data continuing to suggest that the country soon could face a stimulant crisis of major proportions, treatment professionals are offering thoughts on how the health care community should prepare. Will treatment options akin to buprenorphine for opioid dependence emerge, and is a new category of medication-assisted treatment even the answer?

In one common theme, professionals believe another drug crisis inevitably will follow the opioid epidemic, although a high prevalence of polysubstance use makes this issue less clear-cut. “A look at history would lead us to expect a stimulant epidemic following an opioid epidemic,” says Michael Weiner, PhD, research consultant and director of alumni services for Seaside/Behavioral Health of the Palm Beaches, referring back to the effects of opiate-focused anti-drug legislation in the early 20th century.

Weiner added in comments posted about the recent Addiction Professional article on the growing stimulant problem, “It's about time that our profession becomes proactive rather than reactive. All of the data pointing to the next crisis is out there. Question is whether or not we're going to pay attention.”

Documented increases in cocaine- and methamphetamine-related arrests and deaths in pockets of the country, including Florida, Maine and some parts of the West, have caught the attention of research experts. But the data have received considerably less notice among policy-makers who are singlemindedly focused on combating opioid dependence and overdose.

Complicating the picture regarding stimulant addiction is the lack of a “gold standard” medication treatment similar to what the agonist drugs methadone and buprenorphine have become for opioid addiction. There are no federally approved medication treatments for cocaine addiction, and the pace of current research into potential medications (as well as an anti-cocaine vaccine) suggests that marketable products are still years away.

Another Addiction Professional reader warns against placing too much stock in conventional responses anyhow. “History is clear that there will always be a 'next crisis' in drug use,” says Richard Seitz. “Fighting fire with fire (drugs to combat drugs) is not effective in drug abuse and won't do anything other than make the drug companies richer, and soothe our feelings that we are doing 'something.'”

Seitz favors a comprehensive prevention strategy, but one that employs methods more effective than what has been historically used in targeting youths. He cites as an effective and farther-reaching approach the Good Behavior Game, which assists young people with goal orientation, self-regulation, delayed gratification and working in cooperation with peers to achieve goals. He points out that this approach has been shown to achieve a variety of positive outcomes, from improved academic achievement to substantially reduced alcohol and drug use.

I'm interested in your thoughts on what's happening in your communities. Are stimulants emerging as a potential crisis? If so, how are leaders responding?