Cocaine Treatment: Medications

When cocaine abusers seek treatment for their addiction, medications can help them to stop using cocaine. These medications can also reduce the chances of relapse, or an addict's return to using cocaine. A person who suddenly stops using cocaine generally goes through a withdrawal syndrome, with symptoms of depression, anxiety, and craving for cocaine. This craving often lasts for several weeks after a person stops using the drug. Places or things associated with cocaine use in the past, called cues, can continue to trigger cocaine craving for many months. Because of this ongoing craving, it is easy for the abuser to relapse at any time after he or she becomes abstinent . Preventing relapse is an important function of medication treatment.

Cocaine dependence causes changes in the brain, decreasing the ability of the brain chemical dopamine to function normally within the brain. This effect continues for at least two weeks after a patient stops using cocaine. Interference with dopamine within the brain may be involved in causing the cravings for cocaine that create the risk of relapse. Several medications work by reversing these changes in the brain.

Cocaine's effects on the brain may cause some of the symptoms of cocaine withdrawal. The early phase of this syndrome, called the "crash," involves depression, agitation, and increased risk of suicide. Medications that can treat these complications include antipsychotic drugs , such as chlorpromazine and haloperidol. The antipsychotic drug flupenthixol may help with other aspects of cocaine abuse and dependence. In several studies, this drug decreased the intense giddy happiness and/or paranoid psychosis that cocaine abusers experience after they use cocaine. Flupenthixol may be particularly useful as a treatment for cocaine abusers with schizophrenia .

In the crash phase of withdrawal, large doses of benzodiazepine can be used to calm highly agitated patients. Because the crash phase usually lasts for no more than several days, medication does not need to be taken for long periods.

Medications play a more important role during the later phase of withdrawal from cocaine, which may last for several weeks. During this later phase, patients feel depressed and anxious, and crave cocaine. Antidepressants can be given to patients to reduce these symptoms. Studies show that the antidepressant drug desipramine can reduce cocaine craving. As a result, it can help a patient to remain abstinent from cocaine. In one study, cocaine use declined several weeks before cocaine craving was reduced. Another study suggested that the antidepressant drug venlafaxine may be an effective treatment for patients who suffer from both depression and cocaine dependence.

A wide range of medications other than antidepressants have also been tried as treatments for cocaine abuse and addiction. These medications affect the actions of dopamine, serotonin, and other neurotransmitters in the brain. Known as dopaminergic drugs, they appear to take effect within a day after a person begins treatment with them. Because of this quick action, they may reduce the severity of early withdrawal symptoms after cocaine binges . These drugs include amantadine, bromocriptine, and methylphenidate. Studies of amantadine show that it reduces cocaine craving and use for several days to a month. Methylphenidate was effective in reducing cocaine cravings in cocaine users with attention-deficit/hyperactivity disorder (ADHD). People with ADHD may use cocaine as a way to medicate themselves for their problem. They then can become addicted to the drug.

Studies have begun on the development of a cocaine vaccine. The vaccine would produce antibodies that bind to cocaine in the bloodstream and prevent it from traveling to the brain. This action would block the effects of cocaine. The vaccine may be helpful in combination with behavioral therapy .

Multiple-Drug Use

According to the National Institute on Drug Abuse, most cocaine-dependent people also abuse other substances. More than half are dependent on alcohol, and many are dependent on opioids (such as heroin) and benzodiazepines. The use of these drugs in combination has serious medical consequences—often more severe than the use of each drug alone.

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People who are dependent on other substances in addition to cocaine may be treated with a combination of medications. Cocaine abusers who are also dependent on alcohol can take disulfiram (Antabuse), a drug used to treat alcohol abuse. Taking disulfiram before using cocaine may block the pleasurable effects of cocaine and cause such negative effects as anxiety and paranoia. These undesirable effects may discourage a person from cocaine use.

Cocaine abusers who are also dependent on heroin can take the drug naltrexone, which is used to treat opioid abuse. Heroin addicts sometimes take cocaine to increase the euphoria from heroin. As a result, control of heroin abuse in many patients may directly reduce cocaine abuse. Researchers are also studying the possibilities of giving patients who are dependent on both cocaine and opioids an opioid drug that is less addictive than morphine, such as buprenorphine. However, substituting one drug of abuse with another is a very risky treatment approach.

Patients who are dependent on opiates, alcohol, or benzodiazepines in addition to cocaine require detoxification . While cocaine withdrawal does not usually lead to major medical complications, withdrawal from these other drugs can have serious medical consequences. Medications are especially important in the treatment of multiple-drug abuse.