A report from Vancouver has suggested that prescription psycho-stimulant drugs could be helpful in reducing overdoses for people who are relying on illegal stimulants such as methamphetamine and cocaine.
The report was published in the newest edition of the Canadian Medical Association Journal. It was authored by Heather Palis, PhD population and public health, Department of Psychiatry at the University of British Columbia, and by Dr. Scott MacDonald of Providence Health Care in Vancouver.
The authors wrote there is growing evidence that supports treatment of stimulant use disorder with prescription psycho-stimulants, but no pharmacologic treatments for stimulant use disorder are currently approved in Canada.
"Canada is facing an ongoing crisis of poisonings from unregulated drugs. Synthetic opioids like fentanyl are a known driver, but stimulant use is also rising. For example, in nearly half of all opioid deaths in Canada in 2022, a stimulant was also detected," said the report."
Concern was also voiced that people who use psycho-stimulants are exposing themselves to a wide range of both physical health and mental health hazards.
"Accessing the unregulated supply of stimulants can pose several risks, including increased rates of infectious disease, mental health concerns (e.g., sleep impairments, psychosis), overdose and all-cause mortality," said the report.
The risks are especially acute for people in marginal situations with poor health conditions, for people who have financial insecurity, who live in poor housing situations, with insecure legal status and racial discrimination, the authors wrote.
They added that prescribed psycho-stimulants can be helpful to those with addictions.
"Similarly to opioid agonist treatment, prescribed psycho-stimulants can support the management of cravings and withdrawal symptoms in patients with stimulant use disorder and can be prescribed with the overall goal of supporting reductions in illegal stimulant use."
Although this option is not available in Canada, the report said it is being used in other countries.
"No pharmacologic treatment for stimulant use disorder has been approved in Canada. Nevertheless, psychostimulants are increasingly prescribed as harm reduction for stimulant use disorder in Canada, following evidence from clinical trials in Europe, Australia and the United States.
The authors also commented that although the federal health ministry issued a letter in 2020 encouraging the medical community to explore options of prescription drugs as an alternative to contaminated street drugs, only British Columbia has responded with the Safer Supply program.
The authors concluded, "a broader implementation of prescribed psycho-stimulants as an effective option in the continuum of care for stimulant use disorder is needed in Canada; this practice would help the growing number of patients seeking to reduce their reliance on the illegal stimulant supply during the ongoing unregulated drug poisoning crisis.”
A full text version of the CMAJ report can be found online here.