Melinda McDowell had used drugs since she was a teenager. But she didn't try methamphetamine until one fateful night in 2017 after her mother died suddenly of a stroke. She went to a neighbor's house and he had crystal meth.
"I tried it and I was hooked from the first hit," McDowell says. "It was an explosion of the senses. It was the biggest high I'd ever experienced."
Afterward, McDowell says, that big high started getting more elusive. But she kept using the drug frequently, and it took a toll. She went from 240 pounds to 110. Eventually, she lost custody of her children, who were put in foster homes. McDowell started having hallucinations.
McDowell tried many times to stop using meth, but when she'd quit for a few days, she'd have severe panic attacks and begin to shake uncontrollably. One night, she remembers lying on her bathroom floor thinking that if she didn't get help, she'd die.
She heard about a woman named Nancy Beste who had recently opened the doors to a treatment center called Road to Recovery in Steamboat Springs, Colo., near where McDowell lived. McDowell says she begged Beste for help.
Beste, who's a certified addiction counselor and physician assistant, says McDowell's call came at a fortuitous time. She had just gotten back from a conference where she learned about research into what's called medication-assisted treatment, or MAT, for methamphetamine users. Some early studies indicate that naltrexone, the same medication used to treat alcohol addiction and opioids, can work for some people addicted to methamphetamine.
Beste gave McDowell a prescription for naltrexone and signed her up for individual and group therapy. McDowell says that three to four hours after she took the first pill, she felt better. After the second pill, the withdrawals lessened.
"The shaking started going away. I wasn't panicking. I could feel some relief," McDowell says. "I knew there was something different."
That was more than a year ago. McDowell is still sober today.
Nationally, methamphetamine use is soaring, especially in the West, and the treatment community is struggling to come up with the best ways to help.
Medication-assisted treatment with drugs such as methadone, buprenorphine and naltrexone are standard care for people addicted to opioids, but there are currently no FDA-approved medications for meth addiction. Still, a number of practitioners are beginning to experiment with treating meth use disorder with naltrexone — along with other medications like the antidepressant bupropion. And researchers are taking a look at naltrexone for meth, too, finding some promising initial results.
Dr. Keith Heinzerling, an addiction medicine specialist at the Pacific Neuroscience Institute in Santa Monica, Calif., says he prescribes naltrexone off-label, in combination with other medications, for methamphetamine addiction if patients are interested in trying it. And he believes, when combined with physician oversight and counseling, it can be an effective treatment.
"I think there's a great opportunity to try naltrexone," Heinzerling says. "There's actually a decent amount of evidence that it might help, and if I had a family member [addicted to meth], I would recommend they try it."
Heinzerling points to preliminary studies on naltrexone that support the idea that it might help reduce people's cravings for methamphetamine. Heinzerling believes naltrexone can have an anti-addiction effect for many drugs and potentially for other types of compulsive behaviors.
But, he cautions, much is still unknown, and more research on drugs like naltrexone for methamphetamine is needed.
Psychologist Lara Ray, a professor at the University of California, Los Angeles and head of the UCLA Addictions Lab, has done several studies on the effectiveness of naltrexone for methamphetamine addiction.
In one study, published in 2015 in Neuropsychopharmacology, volunteers who used methamphetamine were admitted for a four-day hospital stay. They were given either naltrexone or a placebo, and on the final day, an IV infusion of methamphetamine. The subjects were asked a series of questions, including how strong their cravings were.
"We found that naltrexone is better than a placebo at reducing the cravings for methamphetamine," Ray says.
A large, multisite study led by University of Texas Southwestern Medical Center looks at the effects of Vivitrol — a longer-acting, injected version of naltrexone — combined with bupropion. The study, a randomized, controlled trial, was recently completed and researchers are awaiting results.
Other researchers are trying to come up with new compounds to treat meth addiction. But Ray says there's a more immediate benefit to naltrexone and other drugs already available. She says that although the drugs lack FDA approval for use with methamphetamine addiction, practitioners can choose to prescribe them off-label.
"The good news is that these drugs have been on the market for a while, so we know what side effects there are and the cost-benefits," she says. "So, it's possible for providers to be making individual decisions for individual patients to educate [them] to consider off-label."
She adds that doctors should be aware that "the literature is somewhat preliminary."
Ray says that if she had a family member with the disorder, she would want their treatment provider to experiment with drugs like naltrexone and Vivitrol "in combination with behavioral treatment."
Beste, who also treats patients with opioid addiction, says all of her patients have to do counseling in conjunction with medication-assisted treatment, and the goal is to eventually wean them off those medications. So far, Beste has tried naltrexone with about 16 patients who use meth. Of those, the drug appears to have helped reduce the cravings for methamphetamine in about half of them.
Melissa McDowell of Steamboat Springs says getting off meth has been arduous. But she credits naltrexone for helping her stay sober now for more than a year. It's an uphill battle. McDowell recently learned that the courts had denied her efforts to regain custody of her children.
But she's still pushing forward. McDowell is interviewing for jobs, and at some point, she wants to go to school so she can treat people like herself who want to break free of methamphetamine.