Growing evidence supports prescribing psychostimulants for people at risk of overdose, say researchers

Growing evidence supports prescribing psychostimulant medications to help reduce use of illegal stimulants such as methamphetamine, authors write in a CMAJ (Canadian Medical Association Journal) commentary.

Illegal stimulant use is rising, judging by the presence of these drugs in at least half of all opioid deaths in Canada in 2022.

Following evidence from clinical trials in Australia, Europe and the United States, physicians and nurse practitioners in Canada and other countries are increasingly prescribing psychostimulants as harm reduction for stimulant use disorder.

"This emerging evidence can support prescribers' level of confidence in off-label prescribing of psychostimulants to patients with stimulant use disorder (and particularly for patients with attention-deficit/hyperactivity disorder and stimulant use disorder)," write Drs. Heather Palis, University of British Columbia and Scott MacDonald, Providence Health Care, Vancouver, BC.

In 2020, Canada's Federal Minister of Health issued a letter to the provinces and territories to encourage increasing access to safer pharmaceutical-grade drugs as an alternative to contaminated illegal drugs. Only BC has issued guidance on prescribing psychostimulants to people at risk of overdose.

To help implement prescribed psychostimulants in Canada, the authors suggest that clinical practice guidance should be updated based on new evidence, and that substance use treatment programs and clinics establish protocols to incorporate psychostimulants into the range of interventions.

"Broader implementation of prescribed psychostimulants 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," they conclude.