Potential New Treatment for Cocaine Addiction?

In a recent article, Mariani and colleagues reported on a pilot study of a combination of mixed amphetamine salts (MAS; most commonly known as Adderall) and topiramate (Topamax) in the treatment of cocaine addiction. Their study appeared in the journal Biological Psychiatry (the reference is Mariani et al., Volume 72, Issue 11, 1 December 2012, Pages 950–956.) In the study, subjects were randomized to receive either a combination of MAS and topiramate, an anticonvulsant used for epilepsy and migraine prophylaxis and which is also effective for treating alcohol dependence, or placebo. They found that the proportion of subjects able to achieve 3 consecutive weeks of abstinence from cocaine was significantly better over a 4-week period. The figure below, from the article, shows the difference between the two groups over the course of the study. By study end, 4/13 of subjects receiving the medication combination had complete 3 weeks of abstinence, compared to 0/11 of the control group receiving placebo. No conclusions can be drawn from such a small study, but the results are intriguing. They point to the potential importance of therapies that provide some low potency, long-term stimulation of the receptors involved in a specific addiction. These agonist therapies include current medications such as methadone and buprenorphine (Suboxone) for opioid addiction and varenicline (Chantix) for smoking cessation. Agonist therapies are likely to provide the most effective treatments in the future, as opposed to antagonist therapies that block the receptors and thus the effects of the drug. A current example is naltrexone (Vivitrol) for opioid addiction. Some effectiveness if external coercion is used, but much less or no effectiveness in other circumstances.

MW