Acceptability of Pharmacologic Treatment for Methamphetamine Dependence Among MSM

Pilot Study of Acceptability of Bupropion Treatment for Methamphetamine Dependence Among Men Who Have Sex With Men.

Studies demonstrate that methamphetamine (meth) use is associated with high-risk sexual behavior among MSM, putting meth-using MSM at extraordinarily high risk for transmitting or acquiring HIV. No studies have tested the feasibility and acceptability of conducting pharmacologic interventions to reduce meth use and meth-associated sexual risk behavior among MSM. The purpose of this pilot study is to determine the feasibility enrolling and retaining meth-dependent MSM into a pharmacologic study of bupropion vs. placebo and measuring the tolerability of and adherence to medication among these participants.

Study Overview

• Status: Completed
• Conditions: HIV Infections; Substance Abuse
• Intervention / Treatment: Drug: Placebo; Drug: Bupropion

Detailed Description

The high rate of meth use among MSM is paralleled by evidence of rises in sexual risk behavior and HIV infection among this population. The MSM meth epidemic, and its link with HIV transmission, underscores the need to pilot test new, innovative modalities to reduce meth use and meth-associated sexual risk behavior. Ultimately, a pharmacologic treatment for meth use may not only serve to improve outcomes among those who are accessing current treatment services, but might also benefit those who are not willing or able to utilize such services. While studies show that MSM who enter substance use treatment decrease both their substance use and sexual risk behavior, current behavioral meth treatment programs report low rates of success in treating meth dependence among MSM. We believe the time has come to test the acceptability of pharmacologic interventions to reduce meth use among MSM, and to assess the feasibility of conducting such trials among sexually active, meth-dependent MSM, whose meth-associated sexual behavior use places them at extraordinarily high risk for transmitting or acquiring HIV. In this pilot study, we will provide meth-dependent MSM with placebo or daily bupropion XL (extended-release), a well-tolerated dopamine agonist that has potential to reduce meth use. The specific aims of this study are:

1. To assess the feasibility of enrolling and retaining meth-dependent MSM into a randomized, double-blind study of bupropion versus placebo with biologic (urine meth testing) and behavioral (sexual risk) measures.
2. To explore the tolerability of bupropion and placebo among meth-dependent MSM, as determined by the number of adverse clinical events in the bupropion and placebo arms.
3. To describe the acceptability of bupropion and placebo among meth-dependent MSM, by measuring (via electronic pill caps) medication adherence to bupropion and placebo.

This randomized, double-blind, placebo-controlled, two-arm pilot study will enroll 30 meth-dependent MSM assigned to receive 3 months of bupropion XL 300 mg daily or placebo. We will include both HIV- and HIV-INFECTED MSM, because meth use is common in both groups. We will enroll meth-dependent MSM because they are the most likely population to benefit from this potential treatment. Participants will be seen weekly for urine specimen collection and substance-use counseling. Clinical exams, medical history, specimen collection, and behavioral assessments will be performed at baseline and at the 1, 2, and 3 month visits. Interim visits will be scheduled whenever indicated by signs or symptoms. Our decision to maintain participants on 3 months of bupropion is based on the smoking literature, which demonstrated bupropion's efficacy in treating nicotine addiction within similar time periods; we anticipate that any future efficacy trial will maintain participants on bupropion for this duration.

• Study Type: Interventional
• Enrollment (Actual): 30
• Phase: Phase 2

Contacts and Locations

Study Locations

• United States
  • California
    • San Francisco, California, United States, 94102
      • San Francisco Department of Public Health, HIV/AIDS Office

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 60 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Male

Description

Inclusion Criteria:

• HIV-negative by rapid test or able to document HIV infection through healthcare provider's note or documentation of laboratory test;
• Reports anal sex with men in prior 3 months while using meth
• Diagnosed with meth dependence as determined by SCID
• Interested in stopping or reducing meth use
• Meth-positive urine on screening
• No known allergies to bupropion
• No current acute illnesses
• Able and willing to provide informed consent and to be followed over a 3-month period
• Baseline CBC and electrolytes within institutional limits.

Exclusion Criteria:

• History of seizure
• High risk for seizure, including: recent (last 24 months) head trauma, brain injury or surgery; using theophylline or systemic steroids; prior or current history of anorexia or bulimia; prior or current history of alcohol withdrawal symptoms
• Measured moderate or severe liver disease (LFTs > 3 times normal) or history of chronic liver disease
• Impaired renal function (creatinine clearance < 90 ml/min)
• Evidence of current major depression, as determined by SCID
• Taking anti-depressant medication within last 30 days
• Currently on any bupropion-containing regimen
• Currently using or unwilling not to use pseudoephedrine-containing products (causes false + urines for meth use) for trial duration
• Currently taking antiretroviral therapy (ART)
• CD4 count < 200 cells/mm3
• Any condition that, in the principal investigator's judgment, interferes with safe study participation.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Bupropion; buproprion XL 300mg daily	Drug: Bupropion; Other Names: Wellbutrin
Placebo Comparator: Placebo; placebo 300mg daily	Drug: Placebo

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Feasibility: Proportion of Persons Screened Who Are Eligible and Enrolled		At Enrollment
Feasibility: Proportion of Scheduled Study Visits Completed		12 weeks
Feasibility: Proportion of Urine Samples Collected		12 weeks
Feasibility: Participants Who Completed the Trial		12 weeks
Tolerability: Comparison of Adverse Events in the Bupropion and Placebo Arms.		throughout study
Acceptability: Adherence to Daily Bupropion and Placebo, as Determined by MEMS (Medication Event Monitoring System) Caps Openings	Proportion of days in which the MEMS cap device was opened during of the 12 weeks on study drug.	12 weeks
Acceptability: Adherence to Daily Bupropion and Placebo, as Determined by Self-report	Proportional of reported days taking study drug during the 12 weeks of study.	12 weeks
Acceptability: Proportion of Participants Discontinuing Medication in Both Arms	Proportion of participants who discontinued study medication for at least one week prior to study completion.	12 weeks

Collaborators and Investigators

• Sponsor: San Francisco Department of Public Health
• Collaborators: National Institute on Drug Abuse (NIDA); Public Health Foundation Enterprises, Inc.
• Investigators: Principal Investigator: Grant Colfax, M.D., Co-Director, HIV /AIDS Statistics, Epidemiology and Intervention Research Section

Publications and helpful links

General Publications

• Das M, Santos D, Matheson T, Santos GM, Chu P, Vittinghoff E, Shoptaw S, Colfax GN. Feasibility and acceptability of a phase II randomized pharmacologic intervention for methamphetamine dependence in high-risk men who have sex with men. AIDS. 2010 Apr 24;24(7):991-1000. doi: 10.1097/qad.0b013e328336e98b.

Study record dates

Study Major Dates

• Study Start: September 1, 2006
• Primary Completion (Actual): November 1, 2007
• Study Completion (Actual): November 1, 2007

Study Registration Dates

• First Submitted: April 24, 2006
• First Submitted That Met QC Criteria: April 24, 2006
• First Posted (Estimate): April 26, 2006

Study Record Updates

• Last Update Posted (Estimate): October 17, 2014
• Last Update Submitted That Met QC Criteria: October 9, 2014
• Last Verified: October 1, 2014

More Information

Terms related to this study

• Keywords: HIV; Methamphetamine
• Additional Relevant MeSH Terms: Mental Disorders; Chemically-Induced Disorders; Substance-Related Disorders; Physiological Effects of Drugs; Neurotransmitter Agents; Molecular Mechanisms of Pharmacological Action; Enzyme Inhibitors; Psychotropic Drugs; Neurotransmitter Uptake Inhibitors; Membrane Transport Modulators; Antidepressive Agents; Dopamine Agents; Cytochrome P-450 Enzyme Inhibitors; Antidepressive Agents, Second-Generation; Cytochrome P-450 CYP2D6 Inhibitors; Dopamine Uptake Inhibitors; Bupropion
• Other Study ID Numbers: R21DA021090-1; R21DA021090 (U.S. NIH Grant/Contract)