An Equitable Behavioral Engagement Framework for Stimulant Medication Treatment in Methamphetamine Use Disorder.

Area of Science:

• Addiction Medicine
• Psychiatry
• Pharmacology

Background:

• The 2024 clinical practice guideline conditionally recommends long-acting methylphenidate for amphetamine-type stimulant use disorder, including methamphetamine use disorder.
• This recommendation is based on low-certainty evidence and presents clinical implementation challenges due to methylphenidate's Schedule II status.

Purpose of the Study:

• To review the guideline's recommendation in the context of real-world prescribing challenges.
• To propose a behavioral engagement framework for prescribing psychostimulants for methamphetamine use disorder.

Main Methods:

• Review of clinical safety, monitoring, and access implications.
• Adaptation of a 5-domain framework (adherence, abstinence progress, attendance, alternative activities, accessing support) from buprenorphine treatment.

Main Results:

• Identified a gap in behavioral readiness frameworks for Schedule II stimulant initiation in methamphetamine use disorder.
• Proposed a structured 5-domain framework to guide patient selection and monitoring.

Conclusions:

• The proposed framework integrates objective behavioral engagement metrics with pharmacologic decision-making.
• This approach aims to enhance safety, accountability, and equitable access to emerging stimulant treatment options for methamphetamine use disorder.