Association of Stimulant Use With Dopaminergic Alterations in Users of Cocaine, Amphetamine, or Methamphetamine: A Systematic Review and Meta-analysis
Open accessAbstract
Importance: Stimulant use disorder is common, affecting between 0.3% and 1.1% of the population, and costs more than $85 billion per year globally. There are no licensed treatments to date. Several lines of evidence implicate the dopamine system in the pathogenesis of substance use disorder. Therefore, understanding the nature of dopamine dysfunction seen in stimulant users has the potential to aid the development of new therapeutics. Objective: To comprehensively review the in vivo imaging evidence for dopaminergic alterations in stimulant (cocaine, amphetamine, or methamphetamine) abuse or dependence. Data Sources: The entire PubMed, EMBASE, and PsycINFO databases were searched for studies from inception date to May 14, 2016. Study Selection: Case-control studies were identified that compared dopaminergic measures between stimulant users and healthy controls using positron emission tomography or single-photon emission computed tomography to measure striatal dopamine synthesis or release or to assess dopamine transporter availability or dopamine receptor availability. Data Extraction and Synthesis: Demographic, clinical, and imaging measures were extracted from each study, and meta-analyses and sensitivity analyses were conducted for stimulants combined, as well as for cocaine and for amphetamine and methamphetamine separately if there were sufficient studies. Main Outcomes and Measures: Differences were measured in dopamine release (assessed using change in the D2/D3 receptor availability after administration of amphetamine or methylphenidate), dopamine transporter availability, and dopamine receptor availability in cocaine users, amphetamine and methamphetamine users, and healthy controls. Results: A total of 31 studies that compared dopaminergic measures between 519 stimulant users and 512 healthy controls were included in the final analysis. In most of the studies, the duration of abstinence varied from 5 days to 3 weeks. There was a significant decrease in striatal dopamine release in stimulant users compared with healthy controls: the effect size was -0.84 (95% CI, -1.08 to -0.60; P < .001) for stimulants combined and -0.87 (95% CI, -1.15 to -0.60; P < .001) for cocaine. In addition, there was a significant decrease in dopamine transporter availability: the effect size was -0.91 (95% CI, -1.50 to -0.32; P < .01) for stimulants combined and -1.47 (95% CI, -1.83 to -1.10; P < .001) for amphetamine and methamphetamine. There was also a significant decrease in D2/D3 receptor availability: the effect size was -0.76 (95% CI, -0.92 to -0.60; P < .001) for stimulants combined, -0.73 (95% CI, -0.94 to -0.53; P < .001) for cocaine, and -0.81 (95% CI, -1.12 to -0.49; P < .001) for amphetamine and methamphetamine. Consistent alterations were not found in vesicular monoamine transporter, dopamine synthesis, or D1 receptor studies. Conclusions and Relevance: Data suggest that both presynaptic and postsynaptic aspects of the dopamine system in the striatum are down-regulated in stimulant users. The commonality and differences between these findings and the discrepancies with the preclinical literature and models of drug addiction are discussed, as well as their implications for future drug development.
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In humans, PET imaging studies reported lower baseline dopamine D2 receptor availability in the dorsal striatum in psychostimulant abusers and opioid-dependent subjects compared with control subjects.
“In humans, positron emission tomography imaging studies reported lower baseline dopamine D 2 receptor availability in the dorsal striatum in psychostimulant abusers and opioid-dependent subjects compared with control subjects (Wang et al., 1997;Ashok et al., 2017).”
From Drug Addiction: Hyperkatifeia/Negative Reinforcement as a Framework for Medications Development (2021) · cites this paper as Ashok et al., 2017
The Results section, “Dopamine receptor availability” (page unavailable), reports lower D2/3 receptor availability in stimulant users than in healthy controls. The paper analyzes the whole striatum rather than specifically the dorsal striatum, and its Discussion notes that the tracers generally cannot distinguish D2 from D3 receptors. It does not study opioid-dependent subjects; the citing sentence also cites Wang et al. for that broader claim. (LLM, conf=0.88)
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- Authors
- Ashok, A. H., Mizuno, Y., Volkow, N. D., & Howes, O. D.
- Affiliations
- King's College London (GB)
- National Institute on Drug Abuse (US)
- Corresponding author
- Howes, Oliver D.
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2017-05-01
- Volume
- 74
- Issue
- 5
- Pages
- 511
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC5419581
- OpenAlex
- W2590245649
- Cited by
- 330
- References
- 118
- Citations by year
- 2026: 20 · 2025: 34 · 2024: 37 · 2023: 38 · 2022: 35 · 2021: 49 · 2020: 35 · 2019: 31 · 2018: 41 · 2017: 8 · 2016: 1
- FWCI
- 15.27
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- JAMA Psychiatry (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Spiral (Imperial College London) (submittedVersion)
- Funders
- Eli Lilly and Company
- Japanese Society of Clinical Neuropsychopharmacology
- Wellcome Trust (094849/Z/10/Z)
- Maudsley Charity (094849/Z/10/Z)
- King's College London
- Astellas Pharma
- Mochida Memorial Foundation for Medical and Pharmaceutical Research
- Servier
- H. Lundbeck A/S
- Medical Research Council (MC- A656-5QD30, MR/N026063/1, 094849/Z/10/Z)
- Topics
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- stimulant use disorder, cocaine, amphetamine, methamphetamine, dopamine release, striatal dopamine, dopamine transporter availability, dopamine synthesis, in vivo imaging, positron emission tomography, single photon emission computed tomography, abstinence, dopaminergic dysfunction, treatment development
- MeSH terms
- Corpus Striatum, Dopamine, Humans, Receptors, Dopamine, Amphetamine-Related Disorders, Cocaine-Related Disorders, Dopamine Plasma Membrane Transport Proteins
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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