Testing an Accelerated TMS Protocol for Methamphetamine Use Disorder

In a randomized double-blind parallel-group sham-controlled design (n=20) administer a 5-day accelerated iTBS protocol (40 treatments) to the left dorsolateral prefrontal cortex during a short inpatient stay. Magnetic resonance imaging will be completed pre-post TMS and participants will be followed for 12 weeks.

Inclusion criteria

• Age 21-65 years inclusive;
• Meets DSM-5 criteria for past-year moderate or severe methamphetamine use disorder;
• By Timeline Follow Back endorses at least 10 days of methamphetamine use out of the last month;
• Provides a urine drug screen positive for methamphetamine;
• Able to provide informed consent;
• No change in current psychiatric medication regimen, or medication free, for at least 4 weeks prior to study entry;
• Adequate English proficiency for study consent, and completion of the study instruments.

Exclusion criteria

• Lifetime non-substance-induced psychotic disorders, schizophrenia, schizoaffective disorder or bipolar disorder defined by DSM-5;
• Current diagnosis of DSM-5 drug use disorder other than stimulant, cannabis or nicotine use disorder;
• Non-substance-induced manic episode within the past 3 years or major depressive episode in the past year;
• Current clinically significant neurological disorder or medical illness, including history of seizures, cardiovascular disease/cardiac event, which in the opinion of the study physician would make study participation unsafe;
• Presence of a clinically significant abnormality on baseline MRI;
• Inability to have an MRI;
• Currently breastfeeding, is currently pregnant or lack of use of effective contraception in women of childbearing age, as assessed by urine pregnancy test and self-report (participants will consent to continue effective contraceptives during the study);
• Active criminal justice involvement (i.e., any unresolved legal problems that could jeopardize continuation or completion of the study);
• History of head injury with loss of consciousness for more than 15 minutes;
• Diagnosis of dementia;
• Prescribed benzodiazepines or anticonvulsants;
• Currently enrolled in formal substance use disorder treatment;
• Metal implants or non-removable metal objects above the waist;
• Lifetime history of prior clinical treatment with TMS;
• Serious risk of suicide or homicide;
• Unable/unwilling to follow the study procedures;
• History of intractable migraine;
• Assessed to be at risk for alcohol or opioid withdrawal.