The Stimulant Treatment Gap: NIDA’s 2026 Update on a Crisis With No Approved Cure

The NIDA Clinical Trials Network’s Stimulant Use Disorder (StUD) Task Force published its 2026 update in April, and the core finding remains what it has been for years: there are no FDA-approved medications for cocaine use disorder or methamphetamine use disorder.

That gap is not a minor footnote. Stimulant deaths — primarily methamphetamine and cocaine — reached 57,500 in 2022, with roughly 70% of those deaths involving fentanyl in the drug supply (polysubstance overdose). Stimulant-involved deaths have continued rising even as opioid-only deaths declined. People who use stimulants and opioids simultaneously face dramatically elevated overdose risk.

The treatment landscape today relies heavily on contingency management — providing structured incentives for treatment participation and negative drug tests — which NIDA identifies as the most evidence-based behavioral treatment for both methamphetamine and cocaine use disorder. But contingency management is unavailable in most treatment settings due to regulatory barriers, stigma, and reimbursement challenges.

NIDA’s research pipeline includes several promising directions: monoclonal antibodies designed to bind cocaine or methamphetamine in the bloodstream before the drug crosses the blood-brain barrier, sequestrant molecules that similarly encapsulate methamphetamine, and repurposed existing medications (bupropion, naltrexone combinations) showing signal in subpopulations.

An exenatide (a GLP-1 agonist) trial for cocaine use disorder is also ongoing, following the broader signal from semaglutide’s alcohol data — suggesting that GLP-1 receptor modulation may reach stimulant disorders too.

Why This Matters for People in Recovery

Tens of millions of people have experience with stimulant use, and the lack of an approved medication is a real barrier to recovery pathways that work for opioid use disorder. Rize Recovery’s matching tool includes facilities with contingency management programs. Find evidence-based treatment near you.