EVERETT — Samuel Hirst’s detox center treats patients addicted to opioids. But the vast majority are also hooked on meth.
Hirst can rely on meds specifically formulated to help folks stay off fentanyl, heroin or oxycodone. As for meth?
“There’s no real standard treatment,” Hirst said.
In recent years, meth has consistently driven more than a third of Snohomish County’s overdose deaths. There’s no FDA-approved drug, though, designed to treat meth addiction.
A doctor down the road from Hirst wants to change that.
Providence’s Dr. Thomas Robey is enrolling emergency department patients in a trial-run for new monoclonal antibodies. Just four emergency departments nationwide are testing the new injectable treatment — one Robey said could be a game-changer for locals hooked on meth.
Monoclonal antibodies gained attention this year as a treatment for COVID-19. The molecules are also used for cancer patients, as they target unwanted cells or toxins in the body.
“It’s like an antidote,” Robey told The Daily Herald. “It’s a similar technology to what we use to treat snake bites.”
The drug binds tight to amphetamines in the bloodstream, pulling them away from the central nervous system and allowing the body to excrete them.
Normally, when patients come into the ER in a meth-induced psychosis, Robey’s team can administer sedatives and simply wait for agitation, paranoia and hallucinations to wear off. That can take hours. After that, some doctors prescribe antianxiety medications or antidepressants to help patients try to stay off the drug.
These monoclonal antibodies work differently. Within 30 minutes, enough meth can be removed from the brain that patients are no longer high.
“And that’s really phenomenal,” Robey said. “Because a lot of dangerous activity that individuals engage in when they’re high on meth has to do with paranoia and agitation.”
The “real kicker,” as Robey puts it, is how long-acting the drug is. With a half-life of 19 days, it can act in the body for more than a month. That means patients are blocked from getting high — or as high as they normally would — if they relapse during that time. That month or so could be enough time to help his patients, who are often unhoused, to get an ID, stable housing or other necessary healthcare.
The trial is small. Only 40 patients will be enrolled nationwide. So far, about 10 have been enrolled at Providence. Robey said the results have already been promising. Only one patient has failed to follow up with doctors after receiving the drug.
“I think part of it has to do with the fact that they’re able to get their lives together,” Robey said. “We have so many people in the study who’ve been chronically unhoused who have housing by the time they get to their 30-day followup. It’s unbelievable.”
The long-acting monoclonal antibodies sound promising to Hirst.
“Meth is so difficult for people to put down. Especially with the amount that’s out there right now,” he said. “It’d be a miracle if there’s some way to … keep them sober at least for a couple weeks.”
The research is slow-going, though.
Dr. W. Brooks Gentry is overseeing the national trial. From his office in Little Rock, Arkansas, he recalled the first grant he received to look into this meth treatment. That was back in the 1990s. About $65 million has been poured into the research, but it has come in small, piecemeal grants from the National Institute of Drug Abuse.
“It’s not viewed by entrepreneurial types as something that could be a big money-maker. So they don’t invest,” he said. Plus, “there’s still a bias, I believe, that this is a social ill and not a medical problem.”
Back in the ’90s, Gentry’s colleague was developing monoclonal antibodies targeting PCP, a drug known as “angel dust.”
“What we realized at that point was that Arkansas was No. 1 in the country for the number of methamphetamine labs per capita,” Gentry said. “This was still at the time when local production was a thing.”
So the team shifted their focus to meth. Since then, the meth on the streets has changed. Over the decades, supply has increased, prices dropped and the chemical makeup of the drug has gotten stronger and more dangerous.
When the antibodies were finally ready for human trials, Gentry’s team wanted to use ERs in places with high concentrations of meth use. They used heat maps to figure out where the drug was most prevalent.
“Y’all were unfortunately toward the top of the list,” Gentry said. “It’s heartbreaking for your community that you have such a problem.”
Even so, Robey said he’s thrilled his emergency department is part of the process.
“Even though we’re the safety net,” he said, “patients who are addicted to drugs still often fall through that.”
According to Gentry, federal approval of the drug could take five to six years, if everything goes to plan. He hopes the prospect of a new treatment can give hope to those hooked on meth.
“They tend to give up. Because there’s nothing (to treat meth addiction), so why would I even try?” Gentry said. “And that’s discouraging to hear. If we could give them some hope, that would be a big deal.”