Monday, December 3, 2012

Potential New Treatment for Cocaine Addiction?

In a recent article, Mariani and colleagues reported on a pilot study of a combination of mixed amphetamine salts (MAS; most commonly known as Adderall) and topiramate (Topamax) in the treatment of cocaine addiction. Their study appeared in the journal Biological Psychiatry (the reference is Mariani et al., Volume 72, Issue 11, 1 December 2012, Pages 950–956.) In the study, subjects were randomized to receive either a combination of MAS and topiramate, an anticonvulsant used for epilepsy and migraine prophylaxis and which is also effective for treating alcohol dependence, or placebo. They found that the proportion of subjects able to achieve 3 consecutive weeks of abstinence from cocaine was significantly better over a 4-week period. The figure below, from the article, shows the difference between the two groups over the course of the study. By study end, 4/13 of subjects receiving the medication combination had complete 3 weeks of abstinence, compared to 0/11 of the control group receiving placebo. No conclusions can be drawn from such a small study, but the results are intriguing. They point to the potential importance of therapies that provide some low potency, long-term stimulation of the receptors involved in a specific addiction. These agonist therapies include current medications such as methadone and buprenorphine (Suboxone) for opioid addiction and varenicline (Chantix) for smoking cessation. Agonist therapies are likely to provide the most effective treatments in the future, as opposed to antagonist therapies that block the receptors and thus the effects of the drug. A current example is naltrexone (Vivitrol) for opioid addiction. Some effectiveness if external coercion is used, but much less or no effectiveness in other circumstances.

MW



6 comments:

  1. John Grabowski has contributed many studies in this area. I haven't seen any studies yet using Lisdexamfetamine Dimesylate which I would think would be of more benefit than other psychostimulants due to decreased abuse potential, and the more gradual effects than other psychostimulant delivery methods.

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  2. Very interesting indeed. I know several people who are constantly asking about treatments for cocaine addiction. The agonist principle makes too much sense to ignore - is it likely we might see a similar result with methamphetamine addiction?

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    1. The address below is to a great review of Pharmacological approaches to methamphetamine dependence as of 2010.

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2883750/

      From Abstract:
      "A variety of medications have failed to show efficacy in clinical trials, including a dopamine partial agonist (aripiprazole), GABAergic agents (gabapentin) and serotonergic agents (SSRI, ondansetron, mirtazapine). Three double-blind placebo-controlled trials using modafinil, bupropion and naltrexone have shown positive results in reducing amphetamine or methamphetamine use. Two studies employing agonist replacement medications, one with d-amphetamine and the other with methylphenidate, have also shown promise."

      Br J Clin Pharmacol. 2010 June; 69(6): 578–592.

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  3. It would be great if that really is a cure for cocaine. This would be a great breakthrough that would help industries such that Addiction Rehab New York in curing their patients.

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