A 79-year-old woman has reasonable grounds to claim that a Maine assisted-living facility discriminated against her for being transgender when it rejected her as a potential resident, the Maine Human Rights Commission found.
The commission’s 3-2 vote on Monday sets in motion a process that could result in a lawsuit being filed against Sunrise Assisted Living in the town of Jonesport on a claim of violating state nondiscrimination law by denying Marie King’s application for residency.
King’s attorneys say the case has already made legal history as the nation’s first known discrimination complaint filed by a transgender person against a long-term care facility.
“This kind of discrimination against transgender people needing long-term care is far from an isolated incident, but it is also plainly illegal,” said Karen L. Loewy, senior counsel at Lambda Legal, which is not involved in the case.
In July 2021, a California appellate court struck down a portion of a 2017 state lawthat made it a misdemeanor for nursing home staff to deliberately and repeatedly misgender residents or use their former name — known in the trans community as “deadnaming.” The court found that this part of the law violated staff members’ right to free speech under the First Amendment. The California Supreme Court is reviewing the decision and may ultimately reverse it.
The California law has stood at the vanguard of a nascent movement in Democratic-controlled states to establish explicit legal protections against discrimination for LGBTQ seniors in nursing homes.
Long-term care homes that are specifically geared to welcome the nation’s more than 51 million LGBTQ seniors remain few and far between. But they have begun to crop up across the United States in recent years, including in Philadelphia, New York, Minneapolis, Cleveland, Los Angeles, Chicago, San Francisco and San Diego.
Research indicates that trans seniors are more likely than their cisgender counterparts to require institutionalized care because they tend to have lower incomes, be in poorer healthand be more likely have severed ties from family members.
After King was admitted to Pen Bay Medical Center in Rockport, Maine, in the spring of 2021, a hospital social worker sought to place her in a long-term care facility, given her poor overall health.
According to the legal complaint filed with the state human rights commission in October, an administrator at Sunrise initially told the social worker that there were vacancies.
But after the administrator learned that King is transgender, she allegedly told the social worker that she was rejecting her application because she did not want to place her with a cisgender-woman roommate.
“Long-term care facilities need to understand that they’re going to have lesbian, gay and transgender residents or applicants,” said Chris Erchull, a staff attorney at GLBTQ Legal Advocates & Defenders in Boston, the nonprofit firm representing King.
The human rights commission’s decision, Erchull said, “is a reminder to all assisted-living homes and other long-term care facilities that they have to treat people with respect, compassion and understanding.”
The commission will now attempt to resolve the dispute between King and Sunrise, and barring such a resolution the commission may then file suit against the facility on her behalf.
King’s attorneys also have the option of suing independently of the commission.
Sunrise’s attorney, John K. Hamer, declined to comment.
Contacted through her attorney in January, King stated in an email that she hopes her case “will open doors to a better understanding” of the needs of transgender people.
“I love gay people,” activist and playwright Larry Kramer proclaimed at the outset of a 2004 speech in New York City. “I think we’re better than other people. I really do. I think we’re smarter and more talented and more aware.”
A new study making waves among LGBTQ-focused academics lends empirical credence to the iconic Act Up co-founder’s prideful claims — not to the supposed sweeping superiority of gay men, rather to the more narrow assertion that this group is remarkably inclined to excel academically.
But the paper, which was published in the American Sociological Review on Feb. 20, comes to starkly opposing conclusions about how growing up gay appears to affect the academic performance of males versus females.
University of Notre Dame sociologist Joel Mittleman.Courtesy Amy Levin
Joel Mittleman, a University of Notre Dame sociologist and the paper’s sole author, found that on an array of academic measures, gay males outperform all other groups on average, across all major racial groups. Conversely, he concluded that lesbians perform more poorly in school overall and that Black gay women have a much lower college graduation rate than their white counterparts.
“This article is focusing a lens on what we do to all kids,” Lisa Diamond, a psychology professor at the University of Utah, said of the societal pressures that appear to impede lesbians in schooleven as these stressors possibly unnerve gay males into compensating for homophobia through academic striving. “And the most vulnerable kids are going to show it first.”
In recent years, academics, lawmakers and journalists alike have sounded an increasingly urgent alarm that on balance, American males are stuck in a scholastic funk. As the economic gap between those with and without a college degree has widened, women’s college graduation rate has risen in tandem, but men’s rate has remained largely stagnant for decades. Today, women comprise 59.2 percent of college students, according to the National Student Clearinghouse.
Mittleman’s research indicates that this characterization of the educational gender gap is critically lacking in specificity. It is, in fact, straight males who tend to be mired in a scholastic morass. And the considerable academic progress that young women have charted since the advent of second-wave feminism has been largely restricted to the heterosexuals among them.
Benefit of adding sexuality questions to surveys
Mittleman was able to reach his striking research findings thanks to a move during President Barack Obama’s second term to add questions about sexual orientation to a trio of federally funded, nationally representative surveys. These major annual surveys — which focus on health, drug use and crime victimization — provided the sociologist with information regarding nearly half a million Americans’ diplomas.
Additionally, the National Center for Education Statistics’ High School Longitudinal Study posed questions about sexuality for the first time to the cohort it followed between 2009 and 2017. From this, Mittleman mined a trove of data including 15,270 students’ high school and undergraduate transcripts.
The three surveys of American adults consistently indicated that gay men are far more likely than straight men to have graduated from high school or college, with just over half of gay men having earned a college degree, compared with about 35 percent of straight men. Some 6 percent of gay men have a Ph.D., J.D. or M.D. — a rate 50 percent higher than that of straight men. Mittleman found that gay men’s considerably higher levels of educational attainment hold even after taking into account differences in men’s race and birth cohorts. What’s more, gay men’s college graduation rate dramatically bests even that of straight women, about one-third of whom have a bachelor’s degree.
The longitudinal survey showed that compared with their straight male peers, gay males earned higher GPAs in high school and college, enrolled in harder classes, took school more seriously, had more academically minded friends and had a much lower rate of ever dropping out for a month or more. In stark contrast, these performance disparities were largely reversed when comparing lesbians with straight girls. Most strikingly, 26 percent of lesbians reported at least one dropout period, compared with 15 percent of heterosexual females.
The U.S. lesbian population’s overall college graduation rate, which ranged between 41 percent and 47 percent in the three survey studies, is significantly higher than that of straight women. But Mittleman found this advantage was limited almost entirely to white lesbians, and among women born more recently, gay women’s educational edge has eroded.
Historically, girls have received better grades than boys. But during much of the 20th century, societal constraints — including the predominant expectation that young women would become wives and mothers and not pursue careers — suppressed their graduation rates. In theory, this left lesbians with an advantage. But as constrictions on women’s potential have eased since the 1960s, straight women’s college graduation rate has risen to the point of statistical parity with lesbians among today’s young adults.
The Nancy Drew effect
Searching for the drivers of these differences in school performance between straight and gay students, Mittleman used a machine-learning algorithm to identify response patterns to survey questions that predicted being male versus female among members of the longitudinal cohort. In turn, he found that being atypical for their gender in survey responses helped explain at least part of the gay students’ GPA variation.
This suggested that not just sexual orientation, but its intersection with gender affectation could have influenced how well the gay and lesbians students did in school.
Seeking to explain the sociocultural dynamics possibly at play in these complex equations, Mittleman pointed in his paper to the feminine archetype, long a prized ideal in white, middle-American culture, of the demurely diligent student. (Think Nancy Drew.)
Characterizing masculinity as a fragile and insecure state, Mittleman argued that the long-standing anti-intellectual bias that plagues many American boys is driven in large part by their urge to assert their masculinity by differentiating themselves from the good-girl archetype.
Gay boys, however, appear willing — even eager — to flout gender norms in academics.
“To the extent that it’s feminine to study and appreciate validation in an academic sphere, the gay boys will have an advantage,” Yale School of Public Health psychologist John Pachankis said.
On the flip side, young lesbians may be disinclined to identify with the femininity intrinsic to the good-student ideal, Mittleman suggested. Moreover, by tending to present as more masculine, lesbians may be slapped with a “bad girl” label by educational authorities, subjected disproportionately to school punishment and generally discouraged academically. This could hold especially true for Black girls, whom white authority figures already tend to stereotype as masculine, according to previous research.
“Girls who present as masculine are seen as troublemakers, are seen as suspicious in some way,” Mittleman said.
The ‘Best Little Boy in the World’ phenomenon
An additional factor that Mittleman argued drives the average gay boy to surpass even the average straight girl academically is what’s known in queer psychology as the “Best Little Boy in the World” phenomenon. This refers to the title of the 1973 memoir by former Democratic National Committee treasurer Andrew Tobias, in which he chronicled his youthful crusade to appease his internalized homophobia through admission to Harvard University and other feats of superlative achievement.
In a 2013 paper published in Basic and Applied Social Psychology, psychologist Mark Hatzenbuehler, now of Harvard University, and Pachankis found evidence suggesting that gay male college students indeed sought to compensate for anti-gay stigma by deriving their self-worth in part through academic mastery and other forms of competition.
This psychological paradigm also comprises the bedrock of “The Velvet Rage,” psychologist Alan Downs’ go-to bible for queer men, published in 2005, on “overcoming the pain of growing up gay in a straight man’s world.”
From a young age … I was determined to become a doctor so I could prove to everyone that I could be successful even though I was gay.
DR. CHRIS REMISHOFSKY
While Mittleman is straight, he said he was nevertheless bullied as a child for “not being sufficiently masculine.” His brother, Dr. Chris Remishofsky, is gay and said the findings of Mittleman’s paper closely reflect his personal experience.
“From a young age,” said Remishofsky, a dermatologist in Sterling Heights, Michigan, “I was determined to become a doctor so I could prove to everyone that I could be successful even though I was gay.”
An analysis by the Brookings Institution’s Hamilton Project published in January found that gay male couples earn $30,000 more annually than lesbian couples.
Ilan Meyer, a researcher at UCLA’s Williams Institute, expressed intrigue over the story Mittleman’s paper tells of many gay men apparently overcoming considerable odds. Meyer pointed to the Centers for Disease Control and Prevention’s Youth Risk Behavior Surveillance reports that have chronicled the myriad stressors lesbian, gay, bisexual and transgender young people weather in school and the litany of deleterious impacts, including depression and suicidality.
Indeed, Mittleman found that on the whole, lesbian, gay and bisexual young people reported feeling more unsafe in school and suffered higher levels of discrimination and what’s known as minority stress than their straight peers.
“The effect of resilience to override effectively all stressors is quite amazing,” Meyer said. “We’re basically saying gay boys have a terrible school environment, but still, on average, they’re doing fantastically well. To me, that is still a major question — how does that work?”
The price queer youth pay
Brian Mustanski, a professor of medical social sciences at Northwestern University, cautioned that the relative success of gay men could amount to a double-edged sword.
“While certainly, it’s good news for the young gay men that they’re able to succeed well academically, I do have some real concerns about what kind of pressure they’re putting on themselves,” he said.
Suggesting that feverish academic striving in search of validation can come at a steep cost to mental and physical health, Mustanski pointed to his own research findings that gay men have disproportionately high levels of chronic inflammation. He hypothesized that this physical effect is fueled by minority stress and that it could raise the risk of health problems such as cardiovascular disease.
“We need safe and inclusive policies that protect all students from bullying and differential treatment by school staff regardless of the student’s sexual orientation or gender expression,” Clark said. She called for special support for “those students who may be most likely to face difficulties in school, including sexual minority girls.”
While joining the other experts in praising what he called a “beautifully done study,” UCLA psychologist Patrick Wilsonnevertheless expressed concern that Mittleman’s findings may lead the public to paint student-achievement trends in overly broad strokes.
Noting what an overwhelmingly unsafe place school still is for many queer kids, Wilson further cautioned the public not to conclude, for example, “that a poor Black gay boy living in Montgomery or Mobile, Alabama, feminine-presenting and gender-nonconforming, is actually succeeding in high school right now.”
In a large clinical trial assessing Apretude, ViiV Healthcare’s recently approved injectable drug, as a form of HIV prevention, seven participants contracted the virus despite receiving their injections on schedule.
The new findings indicate that, just as with those who take daily pills to prevent HIV, breakthrough infections are possible among people receiving Apretude.
Dr. Raphael J. Landovitz, who led the Apretude clinical trial in question, told NBC News that he expects such cases of PrEP failure to remain what he characterized as rare, regardless of which form of preventive antiretroviral medication people at risk of HIV receive.
Apretude is nevertheless so efficacious, Landovitz said, that the drug has “the potential to end the HIV epidemic, particularly for people who are challenged with taking oral PrEP.”
Landovitz, an infectious disease specialist at UCLA, said it might always remain unclear why the breakthrough infections among those receiving Apretude occurred. He and his colleagues already know that the blood concentrations of the drug in the first four people to experience such infections weren’t unexpectedly low.
The Food and Drug Administration approved Apretude for use as what’s known as pre-exposure prophylaxis, or PrEP, against HIV on Dec. 20. The long-acting drug, which is meant to be injected every two months by a health care worker, joined two daily pills — Gilead Sciences’ Truvada and Descovy — that were approved as PrEP in 2012 and 2019, respectively.
HIV advocates have looked to Apretude as a potential solution to this enduring medication-adherence problem. And yet, receiving Apretude requires a clinic visit every two months, compared with visits every three months to maintain a prescription to Descovy or Truvada as PrEP.
Men who have sex with men account for an estimated 70 percent of the approximately 35,000 HIV transmissions in the United States each year, according to the Centers for Disease Control and Prevention.
Apretude vs. Truvada
One of the two double-blinded clinical trials that prompted the FDA to approve Apretude for use as PrEP included 4,566 cisgender MSM and transgender women in the U.S. and six other nations in Latin America, Asia and Africa. (A second trial included cisgender women in Africa.) Half of the 1,698 U.S. study members were Black.
The participants, who were all deemed at substantial risk of contracting HIV, were randomized to receive Truvada or Apretude, with each group receiving a corresponding placebo.
In 2020, Landovitz and his colleagues announced that after a median of about 17 months of follow-up during the study’s blinded phase, those who received Apretude had about a two-thirds lower HIV acquisition rate compared with those who got Truvada. This stark difference was driven by suboptimal adherence to the daily Truvada regimen and, by comparison, greater Apretude coverage of the participants’ sex acts.
Dr. Raphael J. Landovitz speaking at the International AIDS Society conference in Paris in 2017.Benjamin Ryan
During that period, the rate of new HIV cases rose in both the Apretude and Truvada groups. This phenomenon, Landovitz suggested, was likely driven by two factors. Firstly, participants’ adherence to both the injection schedule and the pill regimen was lower after the unblinding. Additionally, during this latter trial phase, a greater proportion of the participants were living in Latin America, where the background HIV transmission rates were relatively high.
Nevertheless, Apretude injections maintained about the same rate of superior overall protection against HIV compared with oral PrEP as seen during the trial’s blinded period.
During the combined study periods, 25 people in the Apretude group and 72 people in the Truvada group contracted HIV during a nearly identical amount of cumulative follow-up time.
Breakthrough cases
The seven breakthrough infections among people who received their injections on schedule occurred during a cumulative 4,660 years of follow-up among all those in the Apretude arm of the trial. (During that time, an additional 18 people contracted HIV who did not receive Apretude on schedule.) This means that if a group of 10,000 people in similar circumstances were given Apretude, about 15 of them would be expected to experience breakthrough HIV infections over one year.
Transmission of HIV that is resistant to Apretude’s antiretroviral class, Landovitz said, is “vanishingly rare.” So he said that drug resistance cannot explain breakthrough infections among those receiving the injectable as PrEP.
Breakthrough infections also occurred in at least one, possibly two, people in the Truvada group of the Apretude trial including trans women and MSM. One additional such breakthrough case occurred in the corresponding trial of cisgender women. Further analyses are needed to determine if after each trial’s unblinding, additional people contracted HIV while adhering well to the Truvada regimen.
Research has indicated that compared with concentrations of Apretude in the blood, concentrations of the drug are about 90 percent to 92 percent lower in rectal tissues but only about 80 percent lower in tissues in the vagina and on the cervix. Landovitz told NBC News that these disparities could possibly help explain the emergence of the seven breakthrough infections among those in the Apretude arm of the PrEP study including trans women and MSM. So far, ViiV is able to report that in the PrEP trial including cisgender women, there were no cases of Apretude failure during its blinded phase; further analysis is needed to determine if such breakthrough infections occurred after that study’s unblinding.
Cost and availability
Apretude is not yet widely available in the United States. ViiV is campaigning for insurers to add the injectable preventive to their lists of covered medications.
The pharmaceutical company is up against the fact that multiple generic versions of Truvada hit the market last year and now cost as little as $26 per month. Apretude is priced at the equivalent of $1,850 per 30-day period, similar to Gilead’s pricing of Descovy and brand-name Truvada. The CDC reported at this week’s retrovirus conference that during the first three quarters of 2021, about 42 percent of U.S. PrEP prescriptions were for generic Truvada.
In a paper that Landovitz wrote with Dr. Anne M. Neilan of Harvard Medical School and others and published in the Annals of Internal Medicine on Feb. 1, they conclude that Apretude would need to have a monthly cost no greater than $308 over generic Truvada’s price to remain cost-effective.
Due to the U.S. Preventive Services Task Force granting it an “A” rating in 2019, oral PrEP must now be covered by almost all private insurers with no cost sharing. That means both the medication and the quarterly clinic visits should be free to people with private health plans. Medicaid and Medicare also cover pill-form PrEP, but they may still demand out-of-pocket payments for the prescription.
In the meantime, ViiV will offer a copay card to people with private insurance that will cover up to $7,500 in out-of-pocket expenses related to the injectable drug each calendar year, plus $350 toward injection-administration fees.
Dr. Rupa R. Patel, the PrEP Clinic Lead atWhitman-Walker Health in Washington, told NBC News that Apretude’s considerable efficaciousness notwithstanding, the drug’s every-other-month dosing schedule “is still not ideal.”
“Something taken every six months or 12 months would be better, of course,” Patel said.
Multiple additional forms of long-acting PrEP, dosed as seldom as twice per year, are indeed in the pharmaceutical pipeline. However, Merck announced in December that the company was putting a hold on all clinical development of its experimental drug islatravir after the long-acting antiretroviral was linked to declines in some trial participants’ CD4 immune cells — white blood cells that provide a key indication of immune health. This trend occurred both among those receiving the drug as HIV treatment and in those receiving it as PrEP.
For Roger, the enormity of what he had lost during his nearly two decades of off-and-on methamphetamine use — and what more he had to lose — hit home hard when a man he was dating asked him that question.
Roger, who was 47 at the time, had already suffered a major ischemic stroke thanks to meth, the powerfully addictive stimulant that had long since taken over his life.
So when Roger, who is from Dallas and asked that his last name not be published for fear that meth’s stigma could hurt his career, heard that a study was looking for people like him to test a treatment for meth use disorder, he jumped at the chance.
“I woke up one day and I had no cravings,” Roger, now 50, recalled of the life-altering change he experienced only weeks into the clinical trial.
Just as the National Institute on Drug Abuse, or NIDA, has issued a report detailing the U.S.’s soaring rate of overdose deaths tied to meth, a national research team has reached a milestone by developing what its recent double-blind, placebo-controlled clinical trial has established is the first safe and efficacious medication-based treatment for addiction to the often ruinous stimulant.
While the treatment’s success rate, 14 percent, is modest and important questions remain about its potential for real-world use, the study’s publication in The New England Journal of Medicine last month has nevertheless raised hope in the addiction field that more research might build on its findings. In particular, investigators hope the benefits of the treatment’s two-drug combination of daily bupropion (the antidepressant Wellbutrin) and injections every three weeks of naltrexone (which is used to treat both alcohol and opioid use disorder) could be magnified if it is paired with evidence-based psychosocial support, like cognitive behavioral therapy.
The study’s lead author, Dr. Madhukar Trivedi, a psychiatrist at the University of Texas Southwestern Medical Center in Dallas, described meth addiction as “a very severe illness that affects the person’s health, employment, quality of life, their marriage, self-worth — and it is fatal.”
“For those people who benefit from this treatment, it is very likely to have a positive impact for their lives, as well as societally,” Trivedi said.
Methadone and buprenorphine have long been used to treat opioid use disorder — albeit woefully underused. But when it comes to treating people whose neural reward circuits have been hijacked by meth, there is no comparable approved prescription therapy. That gaping hole in addiction medicine has left the country especially unprepared to deal with a blooming crisis of meth use that, as the opioid epidemic hogs focus and funding, has blindsided small towns and rural communities in particular.
‘The next drug epidemic’
The estimated national population of people with meth use disorder increased by more than 45 percent from 2016 to 2018, from 684,000 to over 1 million, according to the Substance Abuse and Mental Health Services Administration. NIDA researchers estimated in a letter published in JAMA Psychiatry last month that from 2012 to 2018, the national meth-related overdose death rate rose nearly fivefold.
“We have got to find something to help these folks, because meth is becoming the next drug epidemic,” said Dr. Michael Mancino, a psychiatrist and addiction specialist at the University of Arkansas for Medical Sciences.
Once beaten back by major government efforts to clamp down on domestic meth lab production in the mid-2000s, the national meth scourge is surging today, driven by cheap imports funneling in from Mexico, the Drug Enforcement Administration has determined. NIDA’s director, Dr. Nora D. Volkow, said a substantial portion of meth’s growing use appears to be among people who also use drugs like heroin or fentanyl, who may look to stimulant drugs, a category that includes cocaine, to balance out opioids’ depressive effects, or who may take them when they cannot get access to opioids.
“It’s a major problem making the opioid crisis much more lethal than it was before,” Volkow said of the convergence of the drug epidemics.
In 2019, about 16,000 of the more than 70,000 estimated overdose deaths in the U.S. involved meth, and about half of those deaths also included opioids as a factor, according to the Centers for Disease Control and Prevention.
The national drug crisis has only worsened during the coronavirus pandemic. Research published in JAMA in September documented a spike after the first wave of government shutdowns in the use of meth, cocaine, fentanyl and heroin among those diagnosed with or at risk of substance use disorders.
Meth and the gay community
Meth has cast a heavy cloud over the gay community in particular for decades. The National Survey on Drug Use and Health estimated that in 2015, past-year meth use prevalence was more than four times higher among gay men compared to straight men — at 4.1 percent versus 0.9 percent. Research has found that the drug is closely linked to sexual risk-taking among men who have sex with men and that it has been a major driver of HIV transmission among this population.
In November, researchers at the City University of New York published findings in the Journal of Acquired Immune Deficiency Syndrome from an ongoing study of nearly 5,000 sexual and gender minorities who have sex with men and who are considered at risk of HIV infection. The study’s authors found that participants’ odds of contracting the virus during the study were four times higher among those reporting recent meth use and seven times higher among those reporting persistent use of the drug.
Roger, who said he first started taking meth at gay “circuit” parties, said his use of the drug led him to stop going to the doctor and quit taking his HIV treatment a decade ago. His immune health plummeted, and even though he has been back on antiretrovirals since 2014, his T-cell count still has not quite risen back into the fully healthy range.
‘A tremendous signal of hope’
The new meth treatment study was funded by the NIDA, a division of the National Institutes of Health, and conducted in the clinical trials network the institute oversees. The study, which was conducted from 2017 to 2019, enrolled 403 adults who had used meth on at least 18 of the previous 30 days and expressed a wish to cut back or quit.
The study’s authors defined the regimen as effective if at least three-quarters of a participant’s urine screens for meth were negative during the last two weeks of each six-week phase of the trial.
To buttress adherence to the daily pill regimen, the participants were paid $3 every time they logged in to a video app and recorded themselves taking their daily bupropion. The study co-authors said in interviews that the method was likely to have been a driver of the study’s success, considering that previous studies reported lower bupropion adherence, and it could prove challenging to replicate in real-world practice.
Overall, 13.6 percent of the treatment group met the definition of a response, compared with 2.5 percent of the placebo group.
“I had a pipe in the house, I had meth in the house, and after two weeks I was not even looking at it,” Roger recalled of how well the treatment worked for him. “I’d been a daily user for years and years and years.”
Trivedi called the findings “very definitive” and emphasized that the treatment increased success fivefold.
Mancino was more tempered in his assessment, saying, “It’s certainly a start, but the important thing is that we don’t jump to conclusions and say, ‘Oh, here’s the answer.'”
Linda Dwoskin, a professor of pharmaceutical education at the University of Kentucky College of Pharmacy who is researching a novel compound meant to mitigate meth-taking and -seeking behaviors, called the results a “tremendous signal of hope” to families who have been devastated by loved ones’ use of the drug.
Trivedi hopes that a future study including people who use meth less than daily would yield a greater benefit. For now, Volkow said, the goal is to work with the Food and Drug Administration to design a trial that would seek to replicate the recent study’s results while providing the FDA with the data to consider approving the bupropion-naltrexone regimen for meth use disorder.
Dr. W. Brooks Gentry, chief medical officer of InterveXion Therapeutics in Little Rock, Arkansas, who is researching a monoclonal antibody designed to bind to meth and blunt its effects, praised the study’s finding that the treatment was also associated with an overall reduction in the percentage of positive meth urine samples.
In addition, those who received bupropion and naltrexone reported fewer meth cravings and improvements in their quality of life.
“If you can get any kind of reduction and you can get people’s lives to improve, that’s got to be viewed as success,” Gentry said.
Jessica Hulsey, founder and CEO of Addiction Policy Forum, a nonprofit that advocates for people with substance use disorders and their families, said the study sends a powerful message to researchers and pharmaceutical companies that “this is an area where medication development is possible.”
Trivedi and his colleagues speculated that bupropion, which acts on the neurotransmitters dopamine and norepinephrine, may have cushioned the emotional and neurological blow of meth withdrawal. And in theory, naltrexone reduced the euphoric effects of and cravings for meth.
However, Dr. Melissa Zook, a family and addiction physician in London, Kentucky, said the use of naltrexone would be problematic in her practice, because it cannot be combined with buprenorphine. All her patients who report taking meth also use opioids, and they have a strong preference for buprenorphine over naltrexone to treat opioid use disorder, so treating patients for both substance use disorders would present a contraindication.
In addition, the new study could not determine how the bupropion-naltrexone regimen might benefit people over terms longer than just six to 12 weeks.
But three years after the trial, Roger has been on a health kick, having gone vegetarian and gotten a trainer. While he is still taking the bupropion, last summer he stopped the naltrexone his doctor had prescribed to him off label once the study ended.
