Cocaine use disorder - Emerging treatments

Bupropion

Bupropion, a norepinephrine/dopamine-reuptake inhibitor, has been shown to be more efficacious than placebo for achieving sustained cocaine abstinence among people with cocaine use disorder.[53] Guidelines suggest that bupropion can be used for helping achieve cocaine abstinence, particularly among people with co-occurring nicotine/tobacco use or co-occurring depressive disorders.[27]

Topiramate

Topiramate, an anticonvulsant, has been used to treat some addictive disorders. One systematic review of the efficacy of topiramate for substance use disorders found some evidence to suggest that it could be a treatment option for cocaine use disorder.[72] Guidelines suggest that topiramate can be used for helping achieve cocaine abstinence, particularly among people with co-occurring alcohol use disorder.[27]

Modafinil

Modafinil is a mild stimulant that is thought to possibly block the euphoric effects of cocaine. Results have been mixed, although there is some evidence it may be helpful in people with cocaine use disorder who do not have comorbid alcohol use disorder.[73][74] Guidelines suggest that modafinil can be used to reduce cocaine use and improve treatment retention among people without alcohol use disorder.[27]

Amphetamines

The idea of using agonist-like medications (e.g., amphetamines) for the treatment of cocaine use disorder is similar to that of methadone for opioid use disorder. Earlier studies with long-acting amphetamine or methamphetamine had mixed results.[75][76][77] However, one systematic review and meta-analysis found that treatment with prescription amphetamines improved abstinence in patients with cocaine use disorder.[78] Guidelines suggest that extended-release mixed amphetamine salts (given in combination with topiramate) can be used to reduce cocaine use and cocaine craving, particularly among people with co-occurring alcohol use disorder or attention deficit hyperactivity disorder (ADHD). Long-acting amphetamine formulations may also be considered to promote cocaine abstinence, particularly among people with co-occurring ADHD.[27]

Disulfiram

Disulfiram, a treatment for alcohol use disorder, has been studied in people with cocaine use disorder. One systematic review found that disulfiram had no effect on the frequency of cocaine use, amount of cocaine use, and continued abstinence.[79] [ ]

Cocaine vaccine

Several small randomized controlled trials have investigated the use of a vaccine to treat cocaine use disorder, none of which have demonstrated vaccine efficacy compared with placebo.[80] One phase 1 trial assessing the safety and preliminary efficacy of a vaccine designed to prevent cocaine from reaching the brain is ongoing.[81]