Crack cocaine in the Dublin region - Health Research Board

MedicationsA number of studies have concentrated on finding a medicine to alleviate depressionassociated with cocaine use and to reduce cocaine craving. Lima and colleagues(2003) completed a systematic review of 18 randomised control trials on the use ofantidepressants in treating cocaine dependence. The authors found that trials hadnot shown that antidepressants helped reduce cocaine dependence, although thismight have been partly because many people stopped using the antidepressants tooearly. More people might have benefited if they had continued to use antidepressantsfor an appropriate period of time. The findings and recommendations were similar forcocaine users who were also dependent on heroin or were on methadone programmes.Individuals attending treatment programmes may benefit from supervised consumptionof anti-depressants and this approach should be tested using an appropriate researchmethod.Because chronic use of cocaine decreases dopamine concentrations in the brain, itwas thought that pharmacological treatment that controlled dopamine levels couldtheoretically reduce these symptoms and contribute to a more successful therapeuticapproach. Soares and colleagues (2003) evaluated the efficacy and acceptability ofdopamine agonists for treating cocaine dependence through a systematic review of17 studies. The authors reported that dopamine agonists had been used for reducingthe symptoms that patients experienced during the initial period of abstinence fromcocaine. This review of trials found that the evidence of success was not adequate tosupport the use of dopamine agonists as a treatment for cocaine dependence.The anti-convulsant carbamazepine (a tricyclic medication that is widely used totreat a variety of neurological and psychiatric disorders) has been used for treatmentof cocaine dependence. Lima-Reisser and colleagues (2002) examined whethercarbamazepine was effective in the treatment of cocaine dependence through asystematic review of five studies. The review of trials found that carbamazepine hadnot been shown to help reduce cocaine dependence. The drop-out rate from treatmentwas high, adverse effects were common, and there was no significant fall in theparticipants’ cocaine use.Silva de Lima and colleagues (2002) reviewed the efficacy of pharmacotherapy intreating cocaine dependence. The drug treatments included in the trials were groupedinto the following categories: antidepressants, carbamazepine, dopamine agonists,and miscellaneous other drugs. The miscellaneous treatments included naltrexone,mazindol, lithium, disulfiram, phenytoin, nimodipine, lithium carbonate, NeuRecover-SA and risperidone. The effects of these drugs were compared with each other or witha placebo. Seven studies were included in the review. The authors concluded that therewas no current evidence to support the clinical use of most of these drugs, includingdisulfiram, in the treatment of cocaine dependence.130 Crack cocaine in the Dublin region: an evidence base for a crack cocaine strategy