The Q&A: Joy Schmitz

With each issue, Trib+Health brings you an interview with experts on issues related to health care. Here is this week’s subject:

Dr. Joy Schmitz, Ph.D, is the director of the Center for Neurobehavioral Research on Addiction and the Louis A. Faillace, M.D., Professor at McGovern Medical School at UTHealth. She is working with other experts to research new treatments for methamphetamine use disorder in a new study. 

Editor's note: This interview has been edited for length and clarity. 

Trib+Health: Why are rates of methamphetamine use going up in Texas?

Joy Schmitz: It’s hard to put a finger on exactly why the prevalence has increased. Down in Mexico, where most of it comes from, there’s been a surge coming from there. That’s concerning. What we’re seeing come up into Texas is a more potent form of methamphetamine, which just causes more problems.

This is relative to probably a decade ago. So the researchers who follow the trends in the prevalence over time are just reporting there's an upward trajectory compared to 10 or so years ago.

Trib+Health: Why is methamphetamine so addictive?

Schmitz: Methamphetamine is a stimulant. Methamphetamine is similar to cocaine but different in that it has an even faster and stronger onset of action for the person who uses it.

Most of the individuals generally smoke it in the form of "ice" or crystal meth. It goes by a lot of different street names. When it is smoked, it reaches the brain instantly and produces a really strong euphoric effect, a rush feeling. The short-term effects also include feeling very energized, very alert, it’s just that euphoria that’s very strong. It comes on strong and it stays in the system a little bit longer than what we see with other stimulants, and then you crash after that.

It’s that real peak effect followed by a crash for the individual that sets up the pattern for them to seek it again and again to get that extreme effect. It’s a brain effect, it happens quickly and is perceived as pleasurable for some individuals.

Over time as they use it repeatedly their brain becomes used to that effect. It gets to the point where things in the environment that remind them of using start to create a craving. That starts the whole cycle.

Trib+Health: What will this new study accomplish?

Schmitz: The National Institute on Drug Abuse is very interested in developing a treatment to help individuals who suffer from this addiction. Currently, there are no FDA-approved medications that are available, so we’re limited.

NIDA has sponsored a small pilot work that has led up to this current large study. So in the pilot study, they have examined the effects of the medication — it’s actually a medication combination, it’s two medications being administered together.

In the pilot data, it looks very promising.  When we do this kind of research, we decide ahead of time how many responders or successful cases we need to see in order to be convincing or compelling enough to go forward into a large study like this one.

It made it through all that — we’re getting the green light. It’s safe, it’s well tolerated, but we need to study it in a larger population. It’s gone through the pipeline to the point where we’re now able to recruit participants from really around the country.

There are seven sites and they are spread throughout the country. We’re the only site here in Texas. Each site is being asked to enroll approximately 50 to 60 participants. All together, after about a year-and-a-half, we hope to have approximately 370 individuals who have participated in the study and received the medication.

Trib+Health: What is the timeline for this research?

Schmitz: We hope to screen and enroll approximately four individuals per month. Not everyone will qualify. We need to go through a careful initial assessment to make sure that participants are healthy enough to receive these medications, that they don’t have any conditions that would be contraindicated, and that they’re interested in it.

It’s a somewhat demanding trial in that we want to collect a lot of useful information from them. As we go along, we want to really be able to evaluate how well this treatment works. Like with any research trial or any clinical trial, we are going to collect data. They are going to help us frankly.

In return, we hope to help them with this medication and other types of counseling and support we will provide during the study. It’s a 12-week-long commitment. They need to be able to commit that amount of time. We need them to come into our clinic at least twice a week over those 12 weeks.

Our goal then is to be able to enroll maybe three or four participants a month that qualify and that are interested. And then we have about a year-and-a-half up to two years to continue enrolling. Within two years, we hope to treat about 55 or so individuals.