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ASCME


Methamphetamine (“meth”; MA) use in Canada is on the rise. In the past decade, the
number of deaths, hospitalizations, and emergency room visits due to MA and other
stimulant use has increased across Canada. MA is highly addictive. Withdrawal
symptoms include intense cravings, and long-term use can lead to psychosis (such as
paranoia and hallucinations), and increased risk of HIV, Hepatitis C, and cardiovascular
events (such as heart attack and stroke). Right now, there are no approved treatments
for MA use disorder.​​

There is some early evidence that using high-dose psychostimulants as substitution
therapy can be effective against MA use disorder. Studies show that psychostimulants
can reduce cravings and improve mental health, and high doses are safe. Contingency
management, a type of treatment where a person is given an incentive for achieving
certain behaviour change, has been successful in treating substance use disorders. Our
stakeholder consultation showed that people with lived experience and clinicians are
more receptive to using contingency management to support behavioural changes other
than abstinence.

Our study examines the effects of a high-dose stimulant lisdexamfetamine and contingency
management, alone and in combination, on MA use compared with treatment as usual 
(which includes clinical management and behavioural therapies) in individuals with moderate 
to severe MA use disorder. For contingency management, we will incentivize attending clinic 
visits to receive treatment as usual. We will recruit a total of 440 participants in British Columbia, 
Manitoba, Ontario, Quebec, and New Brunswick. Our primary outcome will be self-reported MA 
use; we will also evaluate other key outcomes such as quality of life, craving, mental health, and 
adherence to treatment.

The Lead Principal Investigator for ASCME is Didier Jutras-Aswad. There is also one Site 
Principal Investigator at each Node with expertise in substance use research and addiction 
medicine responsible for the trial sites within their Node (Paxton Bach, Ginette Poulin, 
Bernard Le Foll, Sara Davisdson). The Trial Steering Committee will consist of the Lead
Investigating Principal Investigator, two individuals with Indigenous background and/or 
competencies, two people with lived and living experience, one CRISM nominated Principal 
Investigator, two independent members with relevant expertise in addiction and clinical trials, 
and the National Project Coordinator.

This trial will help improve our understanding of substitution therapy and contingency
management in MA use disorder, which will in turn improve care and support for individuals
who use MA.