Is There Finally a Medication for Meth Addiction? What a New Mirtazapine Trial Found

By The Recover Editorial Team

It is one of the most common questions families ask when someone they love is using methamphetamine: is there a medication for meth addiction, the way there is for opioids or alcohol?

The short answer, in 2026, is still no — not an approved one. The FDA has never approved any medication for methamphetamine use disorder. But that answer is less absolute than it was a year ago, because a large clinical trial published in JAMA Psychiatry has produced the strongest evidence yet that an old, inexpensive generic antidepressant can help people cut back.

The drug is mirtazapine, sold under the brand name Remeron and on the market since the 1990s, prescribed most often for depression and insomnia. Here is what the trial found, and — just as importantly — what it did not.

The 2026 meth addiction clinical trial, in brief

The study is known as the Tina Trial. It was led by the National Drug and Alcohol Research Centre at UNSW Sydney and ran from November 2022 through May 2025 across six outpatient alcohol and other drug clinics in Australia. It was a phase 3, double-blind, placebo-controlled randomized trial — the design that carries the most weight in medicine, and the first of its kind for this drug and this condition.

Researchers randomized 344 adults with moderate to severe methamphetamine use disorder. Of those, 339 received either mirtazapine at 30 mg once daily before bed, or a matching placebo, for 12 weeks. The average participant was 42 years old and 37% were women. These were not occasional users: at the start, participants reported using methamphetamine on a median of 24 out of the previous 28 days.

The question the trial asked was simple. Over 12 weeks, how much would days of methamphetamine use in the past month fall?

What the results showed

Both groups cut back. The placebo group dropped by an average of 4.8 days per month. The mirtazapine group dropped by 7.0 days. The gap between them — 2.2 days — was statistically significant (95% CI, -4.2 to -0.2; P = .02).

That is a real result and a modest one, and the researchers describe it that way. In the two earlier, smaller phase 2 trials that pointed toward mirtazapine, the effect looked larger. Delivered in routine clinical practice to a broader group of people, it diluted. The investigators note an 8% reduction in the risk of using on a given day, compared with roughly 14% in the earlier work.

The secondary results deserve equal billing, because they temper the headline:

• Drug testing did not separate the groups. There was no significant difference in the rate of methamphetamine-negative oral fluid samples, even though self-reported days of use did differ.
• No secondary endpoint reached significance across the full sample — not depression, insomnia, HIV risk behavior, or quality of life. Investigators did report sleep improvements among participants who were depressed at the start, with a trend toward reduced depression in that subgroup.
• The benefit did not appear to run through mood. As in the earlier phase 2 trials, reductions in methamphetamine use were not contingent on improvements in depression or sleep. Whatever mirtazapine is doing here, it does not seem to work simply by treating a co-occurring condition.

Why researchers thought mirtazapine might work

Methamphetamine disrupts dopamine signaling, and most candidate medications for stimulant use disorder have tried to address that directly, usually without success. Mirtazapine takes an indirect route. It modulates dopamine function through its affinity for certain serotonin receptors, and it blocks presynaptic alpha-2 adrenergic receptors, which are dysregulated in methamphetamine addiction. Its antihistamine effects can ease the insomnia and anxiety that are common in this population.

That combination is why the drug kept surfacing as a candidate across two decades of otherwise disappointing stimulant pharmacotherapy research.

Remeron and meth withdrawal: an important distinction

Because mirtazapine is sedating and helps with sleep, it is sometimes searched for as a treatment for meth withdrawal specifically. It is worth being precise about what was and was not studied here.

The Tina Trial did not test mirtazapine as a withdrawal medication. Participants were people actively using methamphetamine who wanted to reduce or stop, treated as outpatients over 12 weeks. The trial measured ongoing use, not the acute crash that follows stopping — the heavy sleep, exhaustion, low mood, and intense cravings that typically peak in the first week or two.

Clinicians do sometimes prescribe sedating medications during stimulant withdrawal to manage sleep disruption, but that is a clinical judgment made case by case, not something this trial validates. Our overview of meth withdrawal symptoms covers the typical timeline and when medical supervision is warranted.

What this does not mean

Coverage of trials like this tends to outrun the trial itself, so a few points are worth stating directly.

• Mirtazapine is not FDA-approved for methamphetamine use disorder. Any use for that purpose in the United States is off-label. Off-label prescribing is legal and routine, but it is a decision made with a prescribing clinician — not something to begin, stop, or adjust based on a news article.
• This is not a cure, and it is not a standalone treatment. Everyone in the trial was receiving care through an outpatient drug and alcohol clinic. The medication was added to that care, not substituted for it.
• There are real side effects to weigh. Drowsiness was reported by 47% of the mirtazapine group versus 33% on placebo. Weight gain affected 10% versus 3%. More people stopped the medication because of adverse events in the treatment group than in the placebo group, 23% versus 15%. Mirtazapine also carries the class boxed warning about suicidal thoughts in young adults, which is a conversation to have with a prescriber.
• Adherence was a problem. Overall adherence across the trial was about 52% — roughly half of prescribed doses, for a single bedtime pill. The chief investigator has pointed to adherence counseling as central to making the medication work outside a research setting.
• The trial ran in Australia for 12 weeks. Treatment systems, prescribing norms, and drug supply differ in the U.S., and U.S. research is ongoing — including a Washington State University trial testing mirtazapine for methamphetamine use among patients already receiving medication for opioid use disorder. An earlier phase 2 trial ran 24 weeks and reported effects that persisted after treatment ended, so whether longer courses do more is unresolved.

Why a modest result still matters

Stimulants are no longer a side story in the American overdose crisis. The CDC reports that nearly 35,000 overdose deaths in 2023 involved psychostimulants with abuse potential, primarily methamphetamine — about a third of all overdose deaths that year (CDC, Overdose Prevention). Provisional federal data show declines through 2024 and 2025, but the category remains enormous.

Opioid use disorder has buprenorphine, methadone, and naltrexone. Alcohol use disorder has naltrexone, acamprosate, and disulfiram. Stimulant use disorder has nothing on the approved list, which means a treatment system organized around prescribing has had nothing to prescribe. In that context, a cheap generic with a measurable effect gives clinicians a conversation they could not previously have on solid evidence.

What effective meth addiction treatment looks like today

For anyone facing methamphetamine use right now, the practical picture has not changed this week. The strongest evidence in stimulant treatment still sits with behavioral care — particularly contingency management, which has more support than any other stimulant intervention, alongside cognitive behavioral therapy and community reinforcement approaches. Structured care typically means medically supervised detox where withdrawal is severe, followed by residential rehab or an intensive outpatient program. Where depression, anxiety, or trauma sit alongside the substance use, dual diagnosis care treats both rather than either alone.

Our overview of methamphetamine covers how the drug affects the body and brain, and our guide to insurance and rehab explains how coverage is usually verified before admission.

Common questions

Is there an FDA-approved medication for meth addiction?

No. As of 2026, the FDA has not approved any medication for methamphetamine or stimulant use disorder. Behavioral treatment remains the standard of care.

What did the 2026 mirtazapine trial actually find?

Adults taking mirtazapine 30 mg daily for 12 weeks reduced their methamphetamine use by 7.0 days per month, compared with 4.8 days on placebo — a difference of about two days. Drug testing results did not differ significantly between the groups.

Can a doctor prescribe mirtazapine for methamphetamine use?

A clinician may prescribe it off-label at their discretion, weighing the evidence against side effects and a person’s medical history. That is a decision for a prescriber who knows the patient, not a self-directed one.

Does mirtazapine help with meth withdrawal?

This trial did not study withdrawal. It studied reduction in ongoing use among people receiving outpatient treatment. Anyone considering medication during withdrawal should raise it with a medical provider.

Talk to someone about treatment options

The Recover connects people with licensed treatment providers across the country. If you are weighing options for yourself or a family member, you can reach our team at 888-510-3898 or browse treatment centers by state. If you are in immediate danger, our crisis resources page lists 24/7 hotlines.

Sources

McKetin R, Shoptaw S, Saunders L, et al. Mirtazapine for Methamphetamine Use Disorder: A Randomized Clinical Trial. JAMA Psychiatry. 2026;83(6):581-589. doi:10.1001/jamapsychiatry.2026.0159. PMID: 41920558. pubmed.ncbi.nlm.nih.gov

National Drug and Alcohol Research Centre, UNSW Sydney. The Tina Trial. unsw.edu.au

Centers for Disease Control and Prevention. About Overdose Prevention. cdc.gov

Mirtazapine for the Treatment of Methamphetamine Use in Opioid Use Disorder Patients Receiving Medication Assisted Treatment. ClinicalTrials.gov NCT06323837. clinicaltrials.gov

This article reports on published research and is not medical advice. Decisions about any medication, including mirtazapine (Remeron), should be made with a licensed prescribing clinician.