Theta burst Transcranial Magnetic Stimulation (TMS) for Methamphetamine use disorder– A feasibility study to inform the design of a multisite randomised control trial.

Summary

Methamphetamine (MA) use, including problematic use is widespread with significant harms to individuals and others. Current treatment options available are limited and effectiveness modest, especially for moderate to severe MA use disorder where serious harms are seen.

This study will examine the feasibility of Transcranial Magnetic Stimulation (TMS) for moderate to severe MA use disorder in ambulatory settings, specifically theta burst stimulation (TBS) TMS.

The study will examine feasibility measures including recruitment, treatment adherence, patient and staff experience. Preliminary efficacy results examined include changes to MA use and cravings with TMS. Drug and Alcohol Clinical Services, Hunter New England Health will also independently fund a neuroimaging sub-study utilising functional magnetic resonance imaging (fMRI) to examine the neurobiological processes associated with cue-elicited craving and TMS treatment in MA use disorder.

The proposed feasibility study aims to inform development of a larger multisite Randomised Control Trial, potentially through Drug & Alcohol Clinical Research and Improvement (DACRIN) collaborating sites to facilitate translation of findings to patients in multiple local health districts (LHDs) across NSW.

TMS is a promising treatment modality for substance use disorders (SUD), with studies documenting positive outcomes for cravings in tobacco, alcohol and cocaine SUD. TMS protocols have been used to target modulation of specific pathways involved in addiction such as reward neurocircuitry, the salience network and inhibitory control.

Importantly, the safety of TMS including TBS protocols have been extensively documented with over a decade of use in a wide variety of clinical settings including depression. There is expert consensus of the safety of TMS and TBS for SUD.

This study will examine the feasibility of TBS protocols of TMS for MA use disorder. TBS requires significantly shorter duration of treatment (2-3 mins only) and fewer treatment sessions compared to other forms of TMS (where sessions are 15-40 mins). This may be more acceptable for clients with MA use disorder.

TMS devices are affordable and staff of existing ambulatory services can be easily trained to administer TMS. It is a scalable and translatable treatment for existing drug and alcohol clinical settings. If proven effective, it has the potential to provide a much-needed adjuvant treatment to existing psychosocial interventions for MA use disorder.