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World-first medication trial for ice addiction

News story

Researchers from the National Drug Research Institute (NDRI) are trialling the efficacy of a promising medication to treat dependence on crystalline methamphetamine, also known as ‘crystal meth’ or ‘ice’.

White bottle containing crystal meth against a blue background.

Australia has one of the highest levels of ice use and dependence in the world. According to the Medical Journal of Australia, since 2010 the number of dependent users in Australia has risen from 72,000 to 160,000, and the number of amphetamine-related hospital admissions and arrests has more than tripled.

In light of this, the multi-institutional research team, led from Curtin by NDRI’s Associate Professor Rebecca McKetin, received a $1.55 million National Health and Medical Research Council grant to conduct a world-first out-patient trial of the medication N-acetyl-cysteine (NAC) to treat addiction to ice.

NAC is an inexpensive medication that has previously been trialled to treat addiction to substances such as cannabis and cocaine, as well as mitigate a range of compulsive behaviours, such as gambling.

“N-acetyl-cysteine has a long use in medicine for other purposes, such as paracetamol overdose and treatment of neuropsychiatric conditions,” McKetin says.

“If found to be effective, this medication has the potential to be a cost-effective treatment option for ice dependence.”

Ice is an addictive and highly pure stimulant drug. It causes a surge in the neurotransmitter dopamine, the brain’s natural pleasure chemical, giving the user intense feelings of euphoria, confidence and energy. Physical effects can include an increase in heart and breathing rates, dilated pupils, a reduced appetite and an increased sex drive.

When ice is smoked or injected, its effects can occur within minutes and usually last between four to 12 hours.

“When they come down from the drug, users feel depressed, paranoid and irritable,” McKetin says.

“This is because the brain’s dopamine levels have been exhausted, creating a short-term deficit while the brain manufactures more. Dependence can occur when users take ice repeatedly to try and regain feelings of normalcy.”

With long-term use, ice can cause changes in the functioning of dopamine and other neurotransmitters, including noradrenaline, which can trigger hallucinations and paranoia. Heavy use can also lead to neurotoxicity of the brain, where nerve terminals start to degenerate due to over-activity.

“The toxicity of the drug in high doses can affect the heart and increase the risk of stroke. It also has a terrible effect on mental health, because those chemicals in the brain that it is acting on constantly, are involved in mood regulation.”

Currently, there is no effective medication to treat addiction to ice, and this is a significant barrier for users seeking treatment. The main form of non-pharmacotherapy treatment is counselling interventions and residential rehabilitation.

For this reason, trialling NAC introduces a novel approach to treating drug addiction: it targets the parts of the brain that reduce cravings, and also protects the brain against neurotoxicity.

NAC helps to reduce cravings by restoring the homeostasis of neurotransmitters in the brain, effectively managing the levels of specific chemicals that regulate the release of dopamine, making it easier for users to manage their desire for the drug. By restoring homeostasis, NAC also protects the brain from over-activity and neural degeneration.

Another key point is that NAC is also relatively inexpensive and can be delivered as a prescribed over-the-counter medication, thereby easing demand on drug treatment services.

“The beauty of NAC is that it works with a whole range of drugs,” McKetin says. “It’s targeting the change in the brain that happens with addiction, rather than the particular substance, so therefore the effects can be carried across different drugs. There are signs of efficacy for tobacco, cannabis, cocaine and meth.”

The N-ICE trial will start in April this year and continue until 2019, with trial sites in Wollongong, Geelong and Melbourne. It will enable McKetin and her research team to potentially detect a reduction in methamphetamine use and changes in a range of clinical outcomes, such as the agitation and paranoia that people experience when they use the drug heavily.

McKetin says the next steps will be to work out how to use NAC in conjunction with other treatments.

“Once we work out whether NAC can help people to reduce their ice use, the next step will be to work out how to use it in clinical practice.

“What we know from epidemiological data is that even if people don’t stop using altogether, if they reduce their use significantly, we actually see a really big reduction in harms. They are much less likely to have psychotic symptoms, much less likely to get aggressive. So, for us, even a moderate reduction in use would be really good.”

The N-ICE trial will be conducted in collaboration with Deakin University, Monash University, the University of Wollongong, the University of Newcastle, La Trobe University and the Burnet Institute.

More information about the N-ICE trial can be found here.

Health at Curtin

This article features in the 2018 Health at Curtin magazine, an annual showcase of some of the University’s most recent, innovative health research.

Comments

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This story has 14 comments

  1. Megan hughes says:

    Hi I would like my 29 year old son to do this Trial I no he is interested We live in Newcastle please Contact me

    • Zoe Taylor says:

      Hi Megan, you can find more information about trial participation, including contact details, here.

    • Penny Dean says:

      wow awesome stuff.
      i swear this trial was made for me.
      great!

  2. Diana says:

    Do you have a trial base in melbourne for ice adiction if so please where is an how can I get in contact with you

    • Zoe Taylor says:

      Hi Diana. Thank you for your comment. There is a trial based in Melbourne. Details can be found here.

  3. Caroline Moss says:

    They are not trailing the drug in Perth if it was possible I would move to Melbourne so I could participate how long before it will be available to the general public.

  4. Vanessa Duncan. says:

    I don’t hallucinate but have been on it for 20 years probably need a hand to get of it, but I definitely have an addictive personality. I don’t chase it all day like most people and the days that I am not on it over the years I am asleep . I am wondering if I qualify for help still.

  5. Hana says:

    I would love for my son to go on the program how can we go about it please help .

    • Zoe Taylor says:

      Hi Hana. Thank you for your comment. There are trials in Wollongong, Geelong and Melbourne. You can find out more info at this N-ICE trial website.

  6. Michael says:

    Is there any plans for a trial to start in Brisbane moving forward?

    Cheers

    • Zoe Taylor says:

      Hi Michael, I am not sure if there are plans for further trial locations, however, you could sign up to the Connections newsletter so you’ll receive up to date information about any progress of the N-ICE trial.

  7. Damian says:

    Hi I’ve been a daily user for 4years now.itd killing me..I only just found out about the medication trail.so I called geelong and all the spots are gone 🙁 I dint wk t to even tell my gp noway.or barwon health as I’m on record for a failed suicide attempt earlier this year and besides being a daily user just now to function and be on anti depressants I can feel myself going into a very dark place..again for that reason dont want this topic brought up to either partys…its hard enough just to email this,but I have nothing to loose and hope you can really help me s.o.s before it destroys me and begin a trial..thanx Damian

    • Zoe Taylor says:

      Hi Damian, I’m sorry to hear about your experience, but please know there is help available. You can call Lifeline on 13 11 14, the Salvo Care Line on 08 9227 8655, or the National Alcohol and Other Drug hotline on 1800 250 015. All these services are free and confidential, and the people there can give you personal help and support.

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