A first-of-its-kind study funded by the Netherlands Organisation for Health Research and Development found promising results for treating co-occurring heroin and cocaine addiction with stimulant medications such as those found in the ADHD medication Adderall.
During the last 15 years, small-scale studies on cocaine addiction treatment using dextroamphetamine — an ingredient in Adderall — resulted in cautiously optimistic findings.
Now, researchers publishing in The Lancet found participants suffering from cocaine and heroin addiction experienced success after receiving extended-release dextroamphetamine in combination with proven heroin medications methadone and morphine.
“Our findings are an important contribution to the search for effective pharmacotherapies for cocaine dependence,” the researchers wrote. “It is the first study that shows the benefits of a robust dose of sustained-release dextroamphetamine as a valuable … medication in the treatment of cocaine dependence.”
Unlike treatment for nicotine, opioid or alcohol addiction, there is no U.S. Food and Drug Administration approved medication for treating cocaine addiction.
The double-blind, placebo-controlled clinical trial involved 73 men in four treatment centers in the Netherlands. The participants were selected after failing two previous treatments for cocaine addiction. Thirty-eight received the experimental treatment, and 35 received placebos.
The dextroamphetamine group reported significantly less cocaine use than the placebo group following the treatment.
However, the study contained limitations. Those receiving dextroamphetamine treatments reported significantly more adverse events, but the authors wrote that “most adverse events were transient and well-tolerated.”
Most participants also regularly consumed alcohol, marijuana or both, making generalized conclusions difficult to determine.
Still, the authors wrote that “sustained-release dexamphetamine is a well-accepted, effective, and safe agonist pharmacotherapy for comorbid treatment-refractory cocaine dependence in heroin-dependent patients in heroin-assisted treatment.”
More than 4.5 million Americans consumed cocaine in 2014, up from 4.1 million in 2013, according to the National Survey on Drug Use and Health. About 20 percent — 913,000 —had a cocaine use disorder.
The number of people who try cocaine each year has remained relatively stable since 2008, but the drug remains one of the most commonly abused illicit substances every year.
Researchers have considered treating addiction to the stimulant with other stimulants for decades. Health care providers use the same concept when treating addiction to opioids, such as oxycodone or heroin. The patient takes a safe dosage of other opioids, such as methadone or morphine, and slowly tapers off the drug.
However, methadone maintenance therapy causes a few serious side effects. Research on stimulant medications has been slow because the drugs can cause hearts attacks, strokes and other severe side effects. Still, the National Institute on Drug Abuse has funded several clinical trials involving the drugs.
A 2000 study published in the Journal of Addiction compared 60 individuals being treated for stimulant addiction with dextroamphetamine to 120 people addicted to heroin being treated with methadone. The individuals recovering from stimulant addiction experienced similar reductions in illicit drug use to those recovering from heroin addiction.
A 2004 study published in the Journal of Neuropsychopharmacology found success in individuals being treated with dextroamphetamine for cocaine addiction in combination with methadone for heroin addiction.
More recently, researchers from the New York State Psychiatric Institute, Columbia University and the University of Minnesota examined the use of extended-release amphetamine salts, such as those in Adderall, in adults with co-occurring cocaine use disorder and attention-deficit/hyperactivity disorder.
ADHD and cocaine addiction commonly co-occur because individuals with ADHD often self-medicate symptoms with cocaine.
The researchers found that extended-release amphetamine salts in combination with cognitive behavioral therapy effectively reduced cocaine use and improved symptoms of ADHD. The findings were published in JAMA Psychiatry in 2015.
A drug must pass several phases of clinical trials to be approved by the FDA. The clinical trials increase in scope and scale until researchers prove the drug is safe and effective. NIDA is currently funding research for several other types of cocaine addiction treatment, including a cocaine-addiction vaccine.
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