Study Finds Antiseizure Drug Promising in Treating Cocaine Addiction

New data suggest that the antiseizure medication topiramate could be a future option in treating cocaine addiction, a study headed by Bankole Johnson, M.D., Ph.D., chair of psychiatry at the University of Maryland and published in JAMA Psychiatry suggests. Johnson led a randomized, double-blind, placebo-controlled trial that included 142 cocaine-dependent subjects and lasted 12 weeks. The results showed that topiramate was significantly more effective than placebo in decreasing craving, reducing cocaine use, and improving global functioning. In short, "We have some great news on a treatment for cocaine dependence," Johnson told Psychiatric News.

"Finding a safe  and effective medication (or vaccine) for the treatment of cocaine-use disorder has been the holy grail of our field for decades," Petros Levounis, M.D., chair of psychiatry at Rutgers New Jersey Medical School and an addiction psychiatrist, said in an interview. "Every few years, an exciting possibility appears on the pharmacotherapy scene, only to fizzle out a little later. For a long time, topiramate has been thought of as one of the more promising medications for the treatment of cocaine addiction, and the present study supports this notion. We hope that our current optimism for the success of topiramate is not once again short-lived. Had the study been longer than 12 weeks, our confidence in the reported encouraging results would be considerably higher."

More information about treating addiction can be found in the American Psychiatric Publishing book Cocaine and Methamphetamine Dependence Advances in Treatment. For recent research in this area, also see the Psychiatric News article, "Scientists Closer to Finding Drugs to Treat Addiction."

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NIDA Researchers Suggest New Direction for Treating Addictions

Using optogenetics, essentially shining a light, on particular cells in the prefrontal cortex can reduce cocaine addiction in rats, according to a study published April 3 in Nature. The senior scientist was Antonello Bonci, M.D., scientific director of the National Institute on Drug Abuse (NIDA). "Our results can be immediately translated to clinical research settings with humans, and we are planning clinical trials to stimulate this brain region using noninvasive methods," Bonci reported in a press statement. "By targeting a specific portion of the prefrontal cortex, our hope is to reduce compulsive cocaine-seeking and craving in patients."

"This exciting study offers a new direction in research for the treatment of cocaine and possibly other addictions," added NIDA Director Nora Volkow, M.D. "We already knew, mainly from human brain imaging studies, that deficits in the prefrontal cortex are involved in drug addiction. Now that we have learned how fundamental these deficits are, we feel more confident than ever about the therapeutic promise of targeting that part of the brain."

Bonci and his colleagues gave cocaine to two groups of rats—those addicted to cocaine and those not addicted to cocaine—then compared the neuron-firing patterns in the prefrontal cortex in both groups. They found less firing in the deep-layer pyramidal neurons of the prefrontal cortex in the addicted rats than in the nonaddicted rats, implying that such sluggish firing might be critical for cocaine addiction. They then used optogenetics to stimulate the underperforming pyramidal neurons in the addicted rats and found that it reduced cocaine-seeking behavior. "Thus, targeted stimulation of the prefrontal cortex could serve as a promising therapy for treating compulsive drug use," the researchers concluded.

More information about advances in treating cocaine can be found in American Psychiatric Publishing's Cocaine and Methamphetamine Dependence: Advances in Treatment.

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Drug Combination Shows Potential for Treating Cocaine Addiction

A combination of buprenorphine and naltrexone can reduce cocaine intake without producing opioid dependence--a promising step toward an effective medical treatment for cocaine addiction in humans, for which there are currently no medications approved by the FDA.

In a study funded by the National Institute on Drug Abuse and published yesterday in Science Translational Medicine, researchers at the Scripps Research Institute in La Jolla, Calif., found that combining low doses of naltrexone with buprenorphine can reduce cocaine intake without inducing opioid dependence in rats. Studies have shown that naltrexone blocks buprenorphine’s actions at one opioid-receptor type that is associated with drug reward (i.e., mu), while preserving its ability to potently interact with a second opioid receptor subtype (i.e., kappa), thought to contribute to compulsive cocaine use.

An implantable, sustained-release form of naltrexone is being investigated in the treatment of polydrug addiction. Read more about it in the Journal Digest column of Psychiatric News, here. 

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