DPH launches meth treatment studies
by Zak Szymanski
Though some community members continue to debate whether methamphetamine use is widespread in the gay community, researchers say available data indicates that meth use still is highly associated with HIV risk, and that those who do use the drug have a greater chance of engaging in high-risk sexual behaviors.
It's a challenge that numerous community groups have addressed over the past several years: how to create and implement programs for harm reduction, drug rehabilitation, and safer sex in order to tackle the intersections of addiction and HIV transmission and acknowledge that in many communities, several epidemics often occur at once.
Enter the San Francisco Department of Public Health, whose approach to these intersections has taken a pharmaceutical turn. Under the supervision of Dr. Grant Colfax, DPH will conduct three separate studies on whether three different medicines seem to affect methamphetamine use and high-risk behavior among men who have sex with men. The studies are based upon a knowledge of "meth's mechanism of action on the brain," said Colfax, who added that while all three drugs - Buproprion, Remeron, and Aripiprazole - are FDA approved for other uses, there are not yet any drugs approved to treat meth addiction. The studies, therefore, will allow researchers to "get a good read" of drugs that may be able to make a difference in that particular field.
Buproprion - perhaps best known as the antidepressant drug Wellbutrin and anti-smoking treatment Zyban - works to stabilize dopamine in the brain.
"We know from prior studies that meth users have depressed levels of dopamine after long periods of use, which may lead to binge episodes in an effort to build dopamine levels back up," said Colfax. "So the idea is that when someone is going through meth withdrawal, we can stabilize their dopamine levels so that they don't have a mass craving. This should help decrease their use."
Known as the "Bump" study, the Buproprion project is currently recruiting participants.
Two additional drugs will be tested in studies that are scheduled to begin around January 2007.
Remeron is an antidepressant that works on both serotonin levels and dopamine pathways, and the hypothesis is that correcting both systems will prevent meth withdrawal and drug-dependency behaviors.
A third drug, Aripiprazole, is usually prescribed as a mood stabilizer. Through a process known as partial agonism, Aripiprazole has an anti-psychotic effect and binds to dopamine receptors in the brain. While full agonism would lead to a "high," partial agonism provides some stimulation believed to mitigate the effects of drug withdrawal. DPH also postulates that "because of the bind to those receptors, people who use meth won't get the high that they usually would," said Colfax.
These particular medicines were chosen not just for their mechanical processes but also because of their minimal effects on sex drive and sexual function. The double-blind studies will include control groups who receive placebos, but all participants will receive financial compensation as well as culturally sensitive behavioral counseling.
The most targeted participants will be "heavy users," said Colfax, who "we think are most likely to be in need of some sort of correction of neurotransmitter dysfunction." While HIV-positive guys are welcome, they cannot be on antiretroviral therapies, as the first studies are preliminary safety studies not equipped to deal with multiple drug interactions.
"We are looking to answer questions about feasibility. Any indication that meth use is reduced will determine a larger study," said Colfax. "This is a foundation on top of which we will build more definitive efficacy trials. We need to see if there is a potential to reduce meth use before we can determine whether the effective drugs lead to a reduction in risk behavior."
A variety of health groups and agencies around the country are studying the effects of antidepressants on addiction, said Colfax, "but as far as I know we are the only ones to look at how they affect a high-risk MSM population specifically. DPH is really taking the lead in trying to find ways to treat meth dependence both in terms of drug addiction but also possibly as an HIV prevention strategy."
Scott Carroll, STD medic at the Berkeley Free Clinic, said he is excited about the studies and hopes to encourage friends and clients in need to enroll.
"If you look at the studies done on addiction and behavioral changes, there's usually a six-month 'action phase' where you're hoping to get someone into the next phase called 'maintenance.' It's usually a huge hurdle for most people; all the issues they may experience with addiction happen in that first six months. If they had something like a pill to deal with the trigger issues that contribute to them falling back into addiction, that's a giant thing. It really does reduce the 'bump' â€“ the mountain â€“ they have to get over," said Carroll, who also does outreach for the vaccine trials unit of the research section of the AIDS office at San Francisco's DPH.
Medication, added Carroll, often breaks the self-perpetuating cycle of depression and continued drug use, he said, noting that regression shouldn't be viewed as failure but that those who do relapse can become even more depressed at their perceived lack of success.
"A lot of times the real trigger is the depression, and people fall back into a comfort zone of medicating themselves out of a lot of the issues we face as gay and bisexual men. If you can find something instead, that's not as destructive as crystal, and get people beyond the knee-jerk reaction of going back to crystal, then you've done a hell of a lot for keeping them healthy and happy. And for people who don't quit, maybe this is something that can help to reduce their use."For more information, call (415) 554-9013 or visit http://www.sfbump.com