The standard treatment for methamphetamine poisoning is “sedate and wait.” There is no antidote to methamphetamine; instead, we typically aim to cover up the unwanted symptoms. We prescribe our favorite sedative, Ketamine or a B52 cocktail (Haldol 5, Ativan 2, Benadryl 50), and often multiple dosages are required to control the agitation and ensure the safety of both the patient and staff.
Our current treatment works well to control the violent scene with security and multiple staff holding down the patient until our hospital medications take effect. When the drama is over, we are left with a sleeping patient who is often unarousable. There is nothing to do but wait, and chances are this passed-out patient will be passed on to the next shift (pun intended). That is the sedate and wait current treatment.
We really need better treatment solutions.
CS-1103 is a new medication that is expected to be a game-changer for methamphetamine. Instead of sedate and wait, CS-1103 will clear the offending drugs out of the body.
The agitated patient with presumed methamphetamine toxicity who is held down to obtain sedating medication will instead receive an IM injection of CS-1103, and within minutes the methamphetamine will be sequestered, and the agitation resolved.
CS-1103 is a small C-shaped molecule that binds methamphetamine and deactivates it on contact, reversing toxic effects in less than two minutes. The drug is a sequestrant that works similarly to Sugammadex (Bridion), which reverses the neuromuscular blockade of rocuronium or vecuronium. CS-1103 also binds fentanyl and cocaine. CS-1103 and the bound drugs are excreted in the urine within about an hour. CS-1103 does not bind THC products.
With the methamphetamine out of the body, the treated patient is no longer under the influence of drugs within minutes instead of hours and should be ready to address the underlying issues that led to intoxication, as well as withdrawal management if the patient had an opioid use disorder.
Now think of the patients waiting for a psychiatric evaluation or clearance. Our specialty has been warning America about psychiatric boarding and the increased volume of mental health patients. Mental health patients often spend many hours in precious ED beds. How many patients are “methicidal,” suicidal because of methamphetamine? With CS-1103, it is predicted that a psychiatrist will not see the ED patient with psychosis or suicidal thoughts until after treatment with CS-1103, clearing any influence of methamphetamine.
Law enforcement often sends patients under the influence of drugs to the ED for jail clearance. The future may include a shot of CS-1103 for these types of methamphetamine- or fentanyl-affected patients.
Patients newly accepted to detox may want CS-1103 to clear their body of drugs and get a head start in recovery.
No doubt there will be more applications for CS-1103 as the drug undergoes more research.
CS-1103 was shown to be safe and well-tolerated in a Phase 1 FDA clinical trial and will enter Phase 2 in late 2024. It will hopefully be ready for emergency department use by mid-2026. CS-1103 will receive its brand name once it passes Phase 3.
Roneet Lev is an emergency physician.
