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For years the focus has been on the opioid crisis, with the rise in use and overdose deaths linked to fentanyl, but in recent years methamphetamine has made a comeback and is also linked to rising overdose deaths. But unlike fentanyl and other highly addictive opiates, which have Methadone and Sub Oxone as treatment options, there has never really been a good option to treat meth addiction.

Dr. Thomas Robey 鈥� an emergency room physician at Providence Regional Medical Center in Everett 鈥� has high hopes a new drug trial he鈥檚 working on can change that.

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鈥淭his treatment is an innovative way to try to buy people some time away from the effects of methamphetamine,鈥� said Robey.

鈥淚t’s an antidote that binds up the meth that’s circulating in the bloodstream. It pulls it away from the brain, in the locations where it causes anxiety and kind of the chaos of the meth intoxication, and it helps shuttle that meth to the kidney and the liver to help the body do its job of getting the poison out of the system,鈥� he explained.

Robey is referring to monoclonal antibody treatments, which may sound familiar given all the headlines it got related to COVID-19 treatment, but it has also been used to treat cancer patients. Robey says the way it works is that it’s an antibody that is very specific to amphetamines 鈥� like an antidote.

鈥淚t works in the same way that we might treat snake bites, or other sorts of toxic congestions,鈥� said Robey.

But it鈥檚 the potentially long-lasting impact that has Robey excited.

鈥淭his antibody stays in the bloodstream for a long time. The half-life is 19 days, which means that in 19 days, half of the drug is still present in the bloodstream. And that results in a long term effectiveness that could stretch out for more than a month,鈥� explained Robey.

The potential benefit of that is huge.

鈥淚’m super excited about this particular agent because methamphetamine addiction is a disease of chaos. And so many of my patients don’t want to be on meth. But when you take meth, it often gets you stuck in a cycle, and this is a way to break that cycle,鈥� Robey said.

If the medication works the way Robey thinks it will, it would give addicted patients a reprieve.

鈥淚t can give them a chance to get an ID to get some of their social services lined up, maybe even get some housing, because the folks who I see in the emergency department are not just suffering from meth addiction, they’re addicted to other drugs, they may be homeless, they may have other medical needs that aren’t being addressed. And being able to get a reprieve from the effects of methamphetamine for a month might just be the key to getting people on the right path,鈥� he said.

Everett was selected for the trial because of its high level of methamphetamine use 鈥� something Robey sees the effects of every day.

鈥淢ost people don’t come to the ER with sniffles, just like most meth users don’t come to the ER because they’re high. What I see in the emergency department is people whose lives have been destroyed by methamphetamine, who are coming in with injuries, who are coming in with unmet medical needs, and who are coming in so agitated and out of control that the police get involved,鈥� Robey said.

鈥淭here doesn’t go a day where someone needs to be sedated because they’re psychotic because of methamphetamine in our emergency department in Everett,鈥� he added.

Robey says the reality is many of the people addicted to meth he meets want to be clean but the only real treatment right now is ongoing cognitive therapy and that’s not only hard to stick to, it鈥檚 hard to pay for.

鈥淏ecause insurers won’t pay for long-term cognitive therapy, and if we had an agent as we do for some of the other drugs that we have treatment for, that could help jumpstart that process, then I see a lot of people who want to get their lives back together, being able to use this,鈥� said Robey.

The treatment would not work like Suboxone or methadone do with opioid addition.

鈥淭he way it’s similar is that it’s a way to get your brain back and your behavior back and it helps stabilize you in the process of getting clean. The way it’s different is that it basically just removes the drug from the system, rather than binding to those receptors that the drug would otherwise bind to. So this is kind of like an antibody that pulls out the drug, whereas methadone and suboxone replaced the drug,鈥� he explained.

The study is small 鈥� just 40 people nationally about a dozen so far here in Everett. The downside is this is not anything that鈥檚 expected to be on the market wide anytime soon.

鈥淚 don’t expect this agent to be available widespread for four to six years. We are in the early stages of an FDA trial. So we’re in the process of recruiting 40 people nationally for phase two of a trial, which is super early in the FDA approval process. And so once we get that data, we can move on to … the phase three trials, which are what is needed to really assure the government and the regulatory agencies that this is a safe and effective drug for this application,鈥� he explained.

鈥淚’m hopeful that this makes it through the approval process. Because to have an agent like this is a game changer.鈥� said Robey.

Others in the field are less enthusiastic but say it is worth exploring.

Dr. Caleb Banta-Greene with the University Of Washington School Of Medicine and Acting Professor at the Addictions, Drug & Alcohol Institute believes when it comes to treatment those addicted to meth, there are larger issues to tackle before getting to the actual meth addiction.

鈥淭he percentage of people who use meth who want to stop/reduce their use is much lower than for opioids as it is serving, often, multiple functional roles in their life- after those drivers of use are addressed (e.g. mental health, relationships, work needs, housing) then they start to address their meth use,鈥� explained Banta-Greene.

The biggest thing he believes we need to do for those addicted to meth right now is to ensure they have access to harm reduction supplies and services to reduce the chances of dying and getting infectious diseases as well as to engage with a caring person who can be supportive and engaging and hopefully, over time, refer them to other services such as primary care, mental health, treatment, and, the number one priority – supportive housing.

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