The Cure for Cocaine Addiction Is...Speed?

Cocaine may not be physically addictive, but it can sure get people in its thrall, snorting away until their wallets empty out, their noses bleed, and their lives implode. Or worse yet, hitting the pipe every five minutes and accomplishing those same exploits even more quickly.

Scientists and researchers have long sought a pharmacological cure for cocaine dependence, with little success—until now. For the first time, researchers are reporting that they've found a drug that cuts down on cocaine use in patients with long-term coke habits: Dexedrine.

That's right: Dextroamphetamine (or dexamphetamine or dexamfetamine), pharmaceutical speed. Meth's more proper and well-behaved little sister. Dexamphetamine is not only a classic amphetamine pill (Dexedrine), but, with just a little plain old amphetamine mixed in, it's also a thoroughly modern ADD and ADHD treatment (Adderall). And now it looks like it can get some hardcore drug users to cut back on the nose candy.

In a study just published in the British medical journal the Lancet, researchers at the Parnassia Addiction Research Center (Bridjer Addiction Treatment) in the Hague, reported significant reductions in cocaine use among their subjects, who formed an especially tough subset of drug users: long-term cokeheads who are also strung out enough on heroin to be enrolled in heroin-assisted treatment programs.

The placebo-controlled trial consisted of 111 patients in heroin maintenance programs who also used cocaine (crack) more than eight days a month and who had already been through at least two other unsuccessful treatment efforts for cocaine. All of them were getting prescription methadone and heroin and 73 got therapy and dexamphetamine, too, while 38 got therapy and a placebo.

"We found SR [sustained release] dexamfetamine to be superior to placebo on all cocaine use–related outcomes, with effect sizes that were at least comparable to those found in studies on other chronic disorders, including alcohol dependence and many other psychiatric and general medical conditions," study investigator Mascha Nuijten told Medscape Medical News.

Dexamphetamine led to "significantly fewer days" of cocaine use, "significantly longer" numbers of days of going without using, and many more subjects (29% versus 6% on placebo) going without for at least three weeks. And the prescription speed was "acceptable and well-tolerated" by the subjects, the researchers said.

Nuitjen said further studies were needed to replicate the findings, both with and without concurrent heroin dependence, and she acknowledged that the why of it was still something of a mystery:  "The exact working mechanisms underlying our positive findings are not yet clear: neither craving reduction nor experienced reward seem to explain the substantial reductions in cocaine use found in the study."

The study earned an interested but cautionary accompanying editorial from the Lancet, in which Dr. Kenneth Dursteler and Marc Vogel of the Psychiatric University Clinics in Basel, Switzerland, write that unlike the case with opiates and tobacco, previous efforts to substitute similar substances (agonist replacement therapy) for cocaine dependence had either come up dry or inconclusive.

"This could be due to limitations in the methods, such as small sample sizes, inadequate dosing schemes, or large attrition rates. The study by Nuijten and colleagues overcomes most of these shortcomings," they wrote. "The results of this study are promising and have important implications for the treatment of cocaine-dependent patients. Although this might not be the 'holy grail' of cocaine-dependence treatment, it could be an important step in the quest for an effective pharmacotherapy of this severe disorder."

But they also noted that even though dexamphetamine caused reductions in cocaine use overall, subjects who got the drug still continued to use cocaine on more than half the days on average.

Commenting on the study for Medscape Medical News, Victor M. Karpyak, psychiatrist and medical director of the Intensive Addiction Treatment Program at the Mayo Clinic, Rochester, Minnesota was even more cautious.

"At the present time, there is no approved medication options for controlling craving for cocaine. In these circumstances, reported research findings are of interest, he told Medscape Medical News. "However, given the highly addictive nature of psychostimulants (including dexamphetamine) and lack of evidence about potential outcomes of the long-term use of this approach, results of this study should be considered with caution and not ready for wide implementation."

In the meantime, has anyone tried coca tea?


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