Medical Treatment for Cocaine Addiction

flumazenil
Flumazenil

Medical treatment for cocaine addiction is controversial and at present there are no federally approved medications specifically designed for cocaine dependence. However, there are some treatments available for addicts that use medications off-label. When a medication is used "off-label", a physician is prescribing it for a purpose beyond its original scope.

Prometa®
Developed by Hythiam, Inc., Prometa is a not a drug per se, but a treatment protocol that consists of combination drug treatment plus therapy. The drug regimen, designed to eliminate cravings, comprises flumazenil, hydroxyzine, and gabapentin. The therapy has not been widely researched but has been widely used, not only in private settings but by the criminal justice system. Prometa is controversial, detractors accusing Hythiam of funneling money to proponents.
Their disclaimer reads, in part: Only a physician licensed to treat with the Prometa Treatment Program can determine if they are appropriate for any individual patient. The medications used in the Prometa Treatment Program are Food and Drug Administration (FDA) approved for uses other than treating dependence on alcohol, cocaine or methamphetamine. Therefore, the risks and benefits of using these medications to treat dependence on these substances have not been evaluated by the FDA.
Sabril (vigabatrin)
Catalyst Pharmaceuticals has designated vigabatrin as CPP-109. The FDA has approved CPP-109 for clinical trials and Fast Track approval status as a treatment for cocaine and metaamphetamine addiction.
Tegretol (Carbamazapine)
This anti-convulsion drug, generally given to patients with epilepsy, has been experimented with as a potential treatment for cocaine addiction but studies have not shown it to be effective. It is used to treat withdrawal symptoms, not to maintain long-term abstinence.
Antidepressants
This class of agents finds use in treating the depression that usually accompanies cocaine withdrawal. The most promising are the selective serotonin reuptake inhibitors (SSRIs). Among them are drugs like Prozac, Paxil and Zoloft.
Seratonin reuptake inhibitors have been theorized as a treatment for cocaine addiction but studies have not been promising.1 The mechanism is appealing however, because SSRIs improve mood by similar neurotransmitter routes. Investigations continue with some hope that larger doses over longer periods may show better results.

Other agents

Finding medications that will help with cocaine addiction is an ongoing effort. In 2006, the Minnesota Medicine Journal reported the following:1

The National Institute on Drug Abuse (NIDA) has been testing drugs approved for other conditions to see if they might reduce cravings for cocaine… The drugs being studied include topiramate, disulfiram, amantidine, baclofen, naltrexone, and modafinil. So far, investigators at Yale University School of Medicine in New Haven, Connecticut, have tested disulfiram in 121 outpatients for 12 weeks. They found the drug decreased the incidence of cocaine use from 2.5 days a week to 0.5 days a week on average. Cocaine use on disulfiram results in an unpleasant or dysphoric experience rather than the expected euphoria.

Another interesting idea is using Ritalin (methyphenidate) as a less harmful, but still addictive, replacement for cocaine. This would mirror the situation with heroin addicts being given methadone. The rationale is that Ritalin interacts with the same areas of the brain that cocaine does.

It is unlikely that even a solid anti-cocaine medication will eliminate the necessity for treatment and maintenance therapy. The availability of cocaine and crack, and the lifestyle choices addicts make, mean that addiction is more than a physiological disease that can be cured by pharmacological means. Even effective medications will remain one component of a larger treatment plan.

Medical Treatments for other types of addictions:

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References

  1. "SSRIs, Drug Withdrawal and Abuse: Problem or Treatment?", Professor C. Heather Ashton, Professor Allan H. Young, Univ. of Newcastle
  2. "When You Suspect a Drug Problem," Minnesota Medicine
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