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Are There Medications for Cocaine Addiction on the Horizon?

Cocaine addiction, diagnosed as cocaine use disorder, affects millions of people around the world.1 Cocaine use disorder involves the compulsive use of cocaine despite the negative medical, psychological, and behavioral consequences of its use.1 According to the 2021 National Survey on Drug Use and Health (NSDUH), around 1.4 million Americans aged 12 and older met the diagnostic criteria for cocaine use disorder in the past year as defined by the American Psychiatric Association’s Diagnostic and Statistical Manual for Mental Disorders (DSM-5).1, 2

There are currently no FDA-approved medications for the treatment of stimulant use disorder, including cocaine use disorder.1 Over the past few decades, researchers have investigated pharmacologic treatments for cocaine addiction, but none have met the requirements for FDA approval, which requires efficacy to be demonstrated in at least 2 adequately powered, randomized, placebo-controlled trials.1

However, certain medications have shown promising results. As researchers continue to investigate potential medications for cocaine use disorder, treatment in the future may involve FDA-approved medication.1, 3

Ready to learn more about treatment for cocaine addiction? American Addiction Centers can help when you call and speak with an admissions navogator. Discuss treatment options, verify your insurance, and more.

Pharmacotherapies Under Study for Cocaine Addiction

Although research is ongoing, there are various reasons why no medications have been approved to treat cocaine addiction thus far.1 According to a clinical review in the journal Substance Abuse and Rehabilitation, many pharmacological treatments have been explored, but limited research has been conducted for each medication.1 Methodological issues, small sample sizes, high drop-out rates, and a lack of diversity in both study design and sample population have also played a role.1 Still, as certain medications have shown positive signals in early studies, researchers argue these should be investigated further.1

Bupropion for Cocaine Addiction Treatment

Bupropion, an aminoketone, non-SSRI (selective serotonin reuptake inhibitor) medication marketed for various uses under widely prescribed brand names such as the antidepressant Wellbutrin, may help promote cocaine abstinence for those struggling with cocaine addiction.1

While the research to date reveals that the effects of bupropion may be relatively small, the American Society of Addiction Medicine (ASAM) states that the potential benefits of bupropion could outweigh the risks, and may be a worthy consideration for people with cocaine use disorder.3 This is also because there is a lack of alternative medications to date that have strong evidence for their usefulness in treating cocaine addiction.3

Bupropion may have added benefits when used as a part of a comprehensive treatment program; for example, 1 clinical trial showed that bupropion may be used to augment the effects of contingency management, a form of behavioral therapy, in promoting abstinence from cocaine use.1

According to the clinical review in Substance Abuse and Rehabilitation, people with cocaine use disorder often have co-occurring mental health disorders, such as depression.1 According to the review, current cocaine use is associated with a nearly tripled risk for depression.1 As it is also useful for treating depression, bupropion may be helpful for people struggling with cocaine use disorder and a depressive disorder.3

Modafinil for Cocaine Addiction Treatment

The American Society of Addiction Medicine (ASAM) indicates that modafinil may be useful for people with cocaine use disorder who do not have a co-occurring alcohol use disorder (AUD).3 Modafinil is a stimulant medication that is sometimes used to treat narcolepsy, and it may help to reduce cocaine use and improve treatment retention.3 ASAM suggests that modafinil may be especially useful for people who are frequent cocaine users when they start treatment; 1 study found that modafinil was superior to placebo in promoting abstinence rates in people who had a higher frequency of cocaine use at the start of the trial.3

Additionally, some research has found that modafinil helped people with cocaine use disorder without co-occurring AUD achieve more days of cocaine abstinence when compared with a placebo.3 Although a follow-up study could not replicate the same results, 1 study found that modafinil increased the likelihood of negative urine samples and chances of achieving cocaine abstinence for more than 3 weeks after treatment.1 Another study showed that, when combined with weekly 1-hour psychotherapy sessions, modafinil was linked to an increased number of cocaine-abstinent days.1

Modafinil may have additional benefits; for example, a small study in an inpatient setting with people who were dependent on cocaine found that modafinil improved working memory and sustained attention compared to people who were randomized to receive escitalopram (an SSRI antidepressant), escitalopram plus modafinil, or a placebo.1

Topiramate for Cocaine Addiction Treatment

Topiramate, an anticonvulsant medication that is often used to treat epilepsy, is another medication that may help reduce cocaine use in people with cocaine use disorder.1 As it is also used to treat alcohol use disorder, it may be helpful for people with co-occurring cocaine use disorder to potentially reduce alcohol use.3

Studies have had conflicting results. A meta-analysis of 5 randomized controlled trials found that topiramate was associated with increased abstinence compared to a placebo.1 Another meta-analysis found that topiramate was associated with a lower amount and frequency of cocaine use for the first 4 weeks of the study, but by week 12 there was no difference between treatment with topiramate and placebo.1 In studies evaluated by the American Society of Addiction Medicine (ASAM), topiramate has had mostly strong evidence for promoting abstinence, but it was not shown to affect other measures, such as treatment retention (a study that showed no effect on abstinence was conducted on people with co-occurring opioid use disorder, which may have impacted these results).3

ASAM indicates that medical professionals may also prescribe a combination of topiramate and extended-release mixed amphetamine salts to people with cocaine use disorder to reduce cocaine use and cocaine craving; this may also be provided to people struggling with co-occurring alcohol use disorder, as it can help reduce alcohol use.3

Prescription Amphetamines for Cocaine Addiction Treatment

A long-acting amphetamine psychostimulant may be prescribed for people with cocaine use disorder as a way of improving cocaine abstinence.3 Several studies have had favorable results indicating that these medications are superior to placebo in terms of promoting sustained abstinence and cocaine-negative urine tests.3 Long-acting prescription amphetamines may also be useful in people with co-occurring attention-deficit/hyperactivity disorder (ADHD), as these medications may help to reduce ADHD symptoms.3

According to the United Nations Office on Drugs and Crime (UNODC), existing evidence supports the use of methylphenidate, another ADHD medication, or amphetamine products for cocaine use disorder, with the strongest evidence for extended-release formulations of these medications, although more research is needed to fully support the benefits.3

Non-Pharmacological Treatment Options for Cocaine Addiction

If you or a loved one are struggling with cocaine misuse or addiction, you should know that cocaine use disorder treatment can help. Although some medications may be used off-label, there are currently no FDA-approved medications to treat cocaine addiction, which is why non-pharmacological options, including behavioral and psychosocial interventions, are the primary focus of treatment.4, 5

Treatment may begin with a period of detox to provide support during withdrawal, followed by inpatient or outpatient rehab, depending on a person’s unique needs.5 Treatment should be individualized; before starting a treatment program, people receive a comprehensive evaluation that considers all of their unique needs to ensure the appropriate rehab placement.6

Behavioral interventions may include cognitive-behavioral therapy (CBT), contingency management, motivational interviewing, and the community reinforcement approach, as well as supplemental therapies and treatments such as exercise and mindfulness practices.5 Behavioral therapies can help people identify and modify unhealthy or unhelpful behaviors in different ways, such as by:6

  • Providing incentives for abstinence.
  • Helping people build their motivation to make positive life changes.
  • Building skills to resist triggers to use and cope with life stresses.
  • Cultivating healthier interpersonal relationships.

Cocaine addiction is associated with high rates of polysubstance use (use of more than 1 substance at a time), particularly alcohol misuse, as well as co-occurring substance use and/or mental health disorders. For this reason, the Substance Abuse and Mental Health Services Administration (SAMHSA) advises that people receive treatment that addresses each concern.4 A lack of treatment for 1 problem can interfere with the successful treatment of the other, which is why integrated treatment is generally preferable to standalone treatment.4

How to Find Treatment for Cocaine Addiction

If you or a loved one is struggling with cocaine addiction, treatment is available. Every program is different, and there are several factors to consider when finding a treatment facility (e.g., insurance accepted, location). You can start the process by talking to your doctor or a qualified mental health practitioner to share your sorry and get referrals. You can also use online tools like our rehab directory to search for a treatment center based on specific criteria.

American Addiction Centers (AAC) is a leading provider of evidence-based addiction treatment with AAC rehabs nationwide. If you’d like to learn more about your treatment options, contact one of our caring admissions navigators . You can also quickly and easily check your insurance coverage for free by filling out the form below.

 

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