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Original pharmacological studies including persons with cocaine abuse or dependence were included in this review if craving was a treatment outcome. Given the variety of nosological classification of cocaine use disorders across the studies included in our review, we use the terms cocaine abuse and dependence interchangeably. Several pre-clinical studies support the potential efficacy of GABAergic medications for the treatment of CUD. GABA is an important modulator of the mesolimbic reward system [109–112], and medications that increase GABAergic activity such as vigabatrin and baclofen have been shown to reduce cocaine self-administration in animal models. Although clinical trials to date have not demonstrated efficacy for baclofen [37], positive outcomes have been found for vigabatrin in a study that ensured high medication adherence [38]. Many types of outpatient treatment programs are available to cocaine users.
Other benefits of the agonist approach include familiarity with drug effects that may promote medication compliance [79–81]. Overall, the mixed results of modafinil trials to date do not suggest significant efficacy of this drug in cocaine users as a whole. However, modafinil has shown efficacy in certain subpopulations of cocaine users, in particular those without comorbid alcohol use. The efficacy of modafinil may also be sensitive to degree of adherence to treatment. In most trials, modafinil has been shown to be well tolerated and it has low abuse liability, making it a potentially safer choice of dopamine agonist for the treatment of CUD.
5. Interventions and Outcomes
Eighty-one cocaine-dependent adults were randomized to receive a combination of MAS-ER and topiramate or placebo for 12 weeks. MAS-ER doses were titrated over 2 weeks to a maximum dose of 60 mg daily, and topiramate doses were titrated over 6 weeks to a maximum dose of 300 mg daily. The overall proportion of subjects who achieved three consecutive weeks of abstinence was larger in the MAS-ER and topiramate group (33.3%) than in the placebo group (16.7%). There was a significant moderating effect of baseline total number of cocaine use days on outcome, suggesting that the combination treatment was most effective for participants with a high baseline frequency of cocaine use (67). Mesocortical dopaminergic neurons receive modulatory inputs from both GABAergic and glutamatergic neurons. As GABA is primarily an inhibitory neurotransmitter in the central nervous system, activation of GABAergic neurons tends to decrease activity in the dopaminergic reward system.
In a meta-analysis of 11 RCTs comparing therapeutic outcomes of modafinil versus placebo, seven studies did not provide evidence for superiority of modafinil over placebo in sustaining cocaine abstinence [101]. However, post-hoc analyses from one study revealed that while modafinil maintenance had no effect on cocaine abstinence, those without a history of alcohol use disorder (AUD) exhibited increased percentage of days abstinent by week [27]. In support of these results, individuals with CUD but not AUD who were treated with modafinil were significantly more likely to abstain from cocaine use during the last 3 weeks of the trial than those who received placebo [29]. Pharmacotherapy for CUD is still limited; no medication has yet been approved for the treatment of CUD.
8. Treatment Dropout
Side effects that can develop as a result of smoking crack include coughing up blood, hoarseness, persistent sore throat, and shortness of breath. Having drug paraphernalia, or other items for using cocaine in your home or apartment can be a sign of addiction too. People with SUD may benefit from 12-step programs in group settings to encourage recovery.
It appears to be more effective for people with alcohol or cannabis addictions. Results are mixed for those using heroin, nicotine, or cocaine or those using multiple substances. It can reinforce motivation to remain sober and target any underlying mental health issues, including anxiety and depression. For most people, the main goal of treatment is maintaining abstinence, as it is significantly linked to a positive long-term prognosis. They can help rewire the brain in a variety of ways to put the person back in the driver’s seat.
Pharmacotherapeutic strategies for treating cocaine use disorder—what do we have to offer?
Acute administration of serotonergic (5HT) agonist meta-chlorophenylpiperazine (m-CCP) [39] led to a substantial reduction (20%) in craving. The 5HT agonist lorcaserin in a single dose showed mixed results; it had anti-craving effect only after placebo IV doses, but not after IV cocaine doses [58]. A total of 84 studies evaluated both craving and cocaine use as outcomes, 76% of them (64) presented a direct correlation between craving and cocaine use after the treatment.
Loved ones may notice a decline in work production or a slide in school grades. Physical health may also be affected as cocaine use can decrease normal appetite, resulting in weight loss and disrupted sleep patterns. Mood swings and irrational behavior may be apparent in someone regularly abusing cocaine as well. Based in part on these very positive human laboratory trials, modafinil was evaluated in several clinical trials but with only mixed results. Some of the differences in trial outcome may be explained by comorbid alcohol abuse among some of the subjects.
Why Cocaine Is So Addictive
Agonist treatment utilizes a substitution approach to replace (or displace) the illicit drug for the purpose of stabilizing functioning. For example, methadone has been a highly effective agonist substitution method for managing opioid use disorder (OUD). https://ecosoberhouse.com/ Cocaine stimulates the mesolimbic dopamine system—the brain’s reward pathway [17]. Cocaine effects are produced through binding to, and inhibiting the function of, monoamine transporters for dopamine (DA), serotonin (5-HT) and norepinephrine (NE) [18].
Even when choosing to go to treatment, people who use drugs face numerous barriers. Last month, researchers from Thomas Jefferson University published an in-depth look at the state of substance use disorder treatment here in Philadelphia. They found little coordination between city and state agencies, making it nearly impossible to identify the number of treatment spots available at any given time.
What Are the Long-term Side Effects of Cocaine Abuse?
According to statistics from the 2021 National Survey on Drug Use and Health, roughly 4.8 million adults 18 and older in the United States reported using cocaine in 2021. It’s possible to die from an overdose of crack or any other type of cocaine. Symptoms include a high heart rate and blood pressure, seizures, hallucinations, and trouble breathing. In early tests, a vaccine helped reduce the risk of relapse in people who use cocaine.
- It causes a naturally occurring neurotransmitter called dopamine to increase its concentration in the brain.
- During medical detox, individuals are monitored around the clock to ensure that all medical and mental health needs are attended to immediately, and sometimes medications are used to help with specific symptoms and drug cravings.
- Use of cocaine is less common in the U.S. than misuse of prescription painkillers (reported by 2.4 million people in the 2021 survey), or use of hallucinogenic drugs (2.2 million).
- Cocaine stimulates the mesolimbic dopamine system—the brain’s reward pathway [17].
- So you might keep taking the drug to prolong the good feelings and put off the unpleasant comedown.
