Cocaine is a powerfully addictive, short-acting stimulant drug with crack smoking being even more addictive than intranasal abuse.  Its use in addicts is strongly associated with craving.  Many medication treatments have been researched for cocaine dependence but only a few appear of value.  Unfortunately, no treatment, either counseling or medication has a powerful effect.  Cognitive-behavioral therapy and faradic aversion therapy have been used with some success, although better research is needed.

Since almost all crack cocaine abusers are cigarette smokers as well and since rapid smoking aversion therapy is the most effective stop smoking technique, I would think that rapid-smoking treatment of tobacco cigarettes by crack cocaine abusers in the presence of cocaine cues might be a useful form of therapy.  This might be augmented by the addition of medications like dexamphetamine, and/or disulfiram, and desipramine if depressed.  Since contingency management with money increases abstinence in methadone maintenance, I wonder if contingency management of dexamphetamine dosage contingent on clean urines might also add a little benefit. 

Memory Damage from Ecstacy and Marijuana: According to a survey study of 763 young adults worldwide, ecstacy damage long-term memory and marijuana short term memory and regular users of both had both types of memory damage. Ecstasy users were 23% more likely to have problems remembering things and cannabis users 20% more likely when compared to non-users. Also, people who regularly take ecstasy or smoke cannabis were more likely to have made mistakes when completing the questionnaires. Jacqui Rodgers, University of Newcastle, J Psychopharmacology 1/15/04

Substance Abuse Markedly Increases Anxiety in Affective Disorders: In a study of 260 adults in a supported socialization program, multivariate logistic regression analyses were used to determine the relationship between anxiety disorders and alcohol and substance use disorders among patients with severe and persistent affective disorders (i.e., major depression and bipolar disorder). Among patients with severe and persistent affective disorders, cocaine (odds ratio [OR] = 5.9), stimulant (OR = 5.1), sedative (OR = 5.4), and opioid use disorders (OR = 13.9) were all significantly more common among those with, compared with those without, anxiety disorders. This association persisted after adjusting for differences in sociodemographic characteristics and comorbid psychotic disorders. Significant associations between panic attacks, social phobia, specific phobia, and obsessive-compulsive disorder and specific substance use disorders were also evident. The relationship between anxiety and substance use disorders among individuals with severe affective disorders. Goodwin RD, et al. Columbia University. Compr Psychiatry. 2002 Jul-Aug;43(4):245-52.

Treatment

Amlodipine, Calcium Channel Blocker, No Help: In a 12-week, DB PC study of 116 cocaine dependent adults, only about 20% completed all 12 weeks of treatment. Both groups showed comparable levels of medication compliance and therapy attendance. In the end, amlodipine was no more effective than placebo in reducing craving or measured levels of cocaine use. A controlled trial of amlodipine for cocaine dependence: A negative report. Malcolm R, Larowe S, et al. Medical University of South Carolina. J Subst Abuse Treat. 2005 Mar;28(2):197-204.

Aversion Therapy (Faradic) Excellent Results (70% 1 year) but No Control Group: Schick-Shadel Hospital in Seattle appears to be the world's only center for the use of aversion therapy for alcohol, marijuana, and cocaine abuse.  This treatment approach started over 50 years ago and has been refined since then.  Emetine is used for alcohol, pairing nausea and vomiting with the consumption of their favorite alcoholic beverage. Small electrical shocks are used for cocaine and marijuana, pairing the various props and actions of abuse with an unpleasant shock. One year abstinence rates averaged 70% for cocaine. Patients who reported losing all urges for cocaine after treatment had a total abstinence from cocaine of 90%, those who reported losing all the uncontrollable urges had a total abstinence of 64%, and those who reported still having the urge reported only 33% total abstinence. One-year follow-up after multimodal inpatient treatment for cocaine and methamphetamine dependencies. Frawley PJ, Smith JW. J Subst Abuse Treat. 1992 Fall;9(4):271-86. Ed: I have been very impressed with the studies of aversion therapy.  I have used a rapid smoking approach for cigarette addiction with good success.  The one year abstinence rates are much higher than with any other approach.  Unfortunately, there is no comparative data for alcohol and cocaine, although the success rates look excellent.

Aversion Therapy (Chemical) Excellent Results but No Controls: An earlier Schick-Shadel study reported 50% total one year abstinence with 80% current (past month) abstinence confirmed by interviews to family members of 90% of patients. The chemical aversion therapy was to develop a conditioned aversion to the sight, smell, and taste of a cocaine substitute (tetracaine, mannitol, and quinine with Psychem. Chemical aversion therapy in the treatment of cocaine dependence as part of a multimodal treatment program: treatment outcome. Frawley PJ, Smith JW. J Subst Abuse Treat. 1990;7(1):21-9

Tiagabine Slightly Helpful in DB: 45 cocaine addicts in methadone program randomized to tiagabine 24 mg/d, 12 mg/d, or placebo. Before study, 1.19 clean urines per week out of 3.00.  On the higher dose, clean urines increased 33%, on lower dose increased 14%, and on placebo decreased 10%. Yale. Tiagabine increases cocaine-free urines in cocaine-dependent methadone-treated patients: results of a randomized pilot study. Gonzalez G, Sevarino K, Sofuoglu M, Poling J, Oliveto A, Gonsai K, George TP, Kosten TR. Addiction. 2003 Nov;98(11):1625-32

Cocaine Dependence: Neither Olanzapine nor Valproate nor L-Carnitine with CoQ10 Helped: In an 8-week DB PC study of 68 cocaine addicts using either olanzapine (10 mg/day), or valproate (1500 mg/day), or coenzyme Q10 (200 mg/day) and L-carnitine (500 mg/day) combination or placebo with all receiving individual cognitive behavioral counseling, none of the study medications were superior to placebo. A placebo-controlled screening trial of olanzapine, valproate, and coenzyme Q10/L-carnitine for the treatment of cocaine dependence. Reid MS, Casadonte P, et al. New York University. Addiction. 2005 Mar;100 Suppl 1:43-57. Ed: Medications aren't of much value.  We need to eliminate drugs from America.  Prevention is the answer, not treatment.  

Desipramine Helps Opioid & Cocaine Abstinence in DB: 180 opioid-cocaine addicts in DB PC study of desipramine 0 or 150 mg/d and methadone or buprenorphine.  Desipramine in opioid-dependent cocaine abusers maintained on buprenorphine vs methadone. Yale. Oliveto AH, Feingold A, Schottenfeld R, Jatlow P, Kosten TR. Arch Gen Psychiatry. 1999 Sep;56(9):812-20; However, no benefit in 59-patient DB. Arch Gen Psychiatry. 1992 Nov;49(11):888-93; Desipramine did help cocaine dependent who were depressed in three DBs. J Psychoactive Drugs. 1991 Oct-Dec;23(4):417-25, Psychopharmacol Bull. 1991;27(3):337-43, and Arch Gen Psychiatry. 1989 Feb;46(2):117-21

Imipramine Small Benefit in DB for Intranasal: 113 patients in a 12-week DB PC study found no impact on freebasers or IV abusers but a significant benefit for intranasal and a trend for greater benefit in those with comorbid depression. Imipramine treatment of cocaine abuse: possible boundaries of efficacy. Nunes EV, McGrath PJ, Quitkin FM, Ocepek-Welikson K, Stewart JW, Koenig T, Wager S, Klein DF. Drug Alcohol Depend. 1995 Oct;39(3):185-95

Stimulants: Methylphenidate Helped Reduce Cocaine Usage: In a 14-week DB PC trial of sustained-release methylphenidate ( MPH ) to placebo (PBO) in treating adult ADHD in 106 cocaine dependent patients, there was no difference in retention rate based on treatment group. The majority of the PBO group and the MPH group reported >30% improvement in their ADHD symptoms (55% versus 47%). There was a decrease in positive urine samples with methylphenidate vs placebo (p=.001). Treatment of cocaine dependent treatment seekers with adult ADHD: double-blind comparison of methylphenidate and placebo. Levin FR, et al. Columbia University . . Drug Alcohol Dep 2007 Feb 23;87(1):20-9.

Stimulants: Methylphenidate Did Not Help ADHD in Methadone Patients: In a 12-week DB PC study of 98 methadone-maintained patients with adult ADHD, with 53% meeting DSM-IV criteria for cocaine dependence/abuse. Comparing placebo to here were no differences in retention rate based on treatment group. A reduction in ADHD symptoms using the adult ADHD rating scale was observed in all three groups, but there were no significant differences in outcome between treatments. The placebo response rate was high, with 46% of the placebo group self-reporting substantial improvement in their ADHD symptoms (>30% reduction in adult ADHD rating scale). There was no evidence of misuse of medication or worsening of cocaine use among those randomized to methylphenidate. Taken together, sustained-release methylphenidate or sustained-release bupropion did not provide a clear advantage over placebo in reducing ADHD symptoms or additional cocaine use in methadone-maintained patients. Treatment of methadone-maintained patients with adult ADHD: double-blind comparison of methylphenidate, bupropion and placebo. Levin FR, et al. Columbia University . . Drug Alcohol Depend 2006 Feb 1;81(2):137-48.

Stimulants: Methylphenidate Didn’t Lower Cocaine Abuse in Small Study: In a 12-week DB PC trial of methylphenidate versus placebo in 48 cocaine-dependent attention-deficit/hyperactivity disorder (ADHD) adults, there were no group differences in self-reported cocaine use, urinalysis results, or cocaine craving. Subjective reports of ADHD symptoms did improve and did not worsen cocaine use while participants were in treatment. Double-blind placebo-controlled trial of methylphenidate in the treatment of adult ADHD patients with comorbid cocaine dependence. Schubiner H, et al. Wayne State University . . Exp Clin Psychopharm 2002 Aug;10(3):286-94. Ed: There was no incentive to avoid cocaine. In my experience, such patients are willing to do so in order to receive the methylphenidate.

Stimulants: No Clear Benefit in Methadone Maintenance: In a DB PC study of 12-weeks for 98 methadone-maintained patients with adult ADHD, with 53% meeting DSM-IV criteria for cocaine dependence/abuse and in a methadone program, there were no differences in retention rate based on treatment group of bupropion vs. methylphenidate vs. placebo. A reduction in ADHD symptoms using the adult ADHD rating scale was observed in all three groups, but there were no significant differences. The placebo response rate was high, with 46% of the placebo group self-reporting substantial improvement in their ADHD symptoms (>30% reduction in adult ADHD rating scale). Using other ADHD outcome measures, the placebo response and medication response rates were substantially lower. There was no evidence of misuse of medication or worsening of cocaine use among those randomized to methylphenidate. Taken together, sustained-release methylphenidate or sustained-release bupropion did not provide a clear advantage over placebo in reducing ADHD symptoms or additional cocaine use in methadone-maintained patients. Treatment of methadone-maintained patients with adult ADHD: double-blind comparison of methylphenidate, bupropion and placebo. Levin FR, et al. Columbia University. . Drug Alcohol Depend 2006 Feb 1;81(2):137-48.

Stimulants: Dexamphetamine Helps in DB: 30 IV cocaine addicts in DB PC of 60 mg/day amphetamine. Dirty urines decreased from 92% to 56% vs. no change with placebo. Decreased self-reported use, criminal activity, and craving. Australia. Pilot randomized double blind placebo-controlled study of dexamphetamine for cocaine dependence. Shearer J, Wodak A, van Beek I, Mattick RP, Lewis J. Addiction. 2003 Aug;98(8):1137-41

Stimulants: Dexamphetamine Sustained Release Helps in DB: A 128-patient 12-week DB PC study started with 15 or 30 mg and increased to 30 or 60 mg at 5 weeks. Placebo had highest number of dirty urines and high dose dexamphetamine the least. U Texas-Houston. Dextroamphetamine for cocaine-dependence treatment: a double-blind randomized clinical trial. Grabowski J, Rhoades H, Schmitz J, Stotts A, Daruzska LA, Creson D, Moeller FG. J Clin Psychopharmacol. 2001 Oct;21(5):522-6. Ed: 60 mg/d is a good sized dose with a cost of roughly $130 per month. Still, the benefits look worthwhile. A recent study of adult ADHD used an average of 21 mg/d. J Child Adolesc Psychopharmacol. 2000 Winter;10(4):311-20. Child dosages are usually 0.15 mg/kg/dose given b.i.d.  Perhaps, the high dose is why the dexamphetamine studies have found benefit but the methylphenidate studies below have not.

Stimulants: Methylphenidate Helped Only ADHD Symptoms in Cocaine Addicts: In a 12-week DB PC study of 48 adult cocaine addicts with ADHD, those given methylphenidate had significantly greater ADHD symptom relief. However, there were no group differences in self-reported cocaine use, urinalysis results, or cocaine craving. Double-blind placebo-controlled trial of methylphenidate in the treatment of adult ADHD patients with comorbid cocaine dependence. Schubiner H, et al. Wayne State University. Exp Clin Psychopharmacol. 2002 Aug;10(3):286-94

Stimulants: Methylphenidate Might Have Helped in Uncontrolled Study: Twelve patients with adult ADHD and cocaine dependence were entered into a 12-week trial of divided daily doses of sustained-release methylphenidate ranging from 40 to 80 mg. Patients reported reductions in attention difficulties, hyperactivity, and impulsivity. Self-reported cocaine use and craving decreased significantly. Cocaine use, confirmed by urine toxicologies, also decreased significantly. Methylphenidate treatment for cocaine abusers with adult attention-deficit/hyperactivity disorder: a pilot study. Levin FR, et al. Columbia University . J Clin Psychiatry 1998 Jun;59(6):300-5.

Stimulants: Methylphenidate Didn’t Lower Cocaine Abuse in Small Study: In an 11-week DB PC study of 24 cocaine-dependent patients, methylphenidate (5 mg plus 20-mg sustained release) or placebo at 8:00 a.m., with afternoon and weekend take-home doses (20 mg sustained-release or placebo), the two groups were equivalent in terms of retention (methylphenidate 48% and placebo 42%) and had similar cocaine use outcomes (40% benzoylecgonine-positive urine screens). There were no significant adverse effects. Replacement medication for cocaine dependence: methylphenidate. Grabowski J, et al. University of Texas-Houston. . J Clin Psychopharm 1997 Dec;17(6):485-8. Ed: In this study, patients had no incentive to avoid cocaine, since methylphenidate continued regardless.

Stimulants: Modafinil (Provigil) May Help Cocaine Addicts: In a DB PC study of 62 cocaine-dependent patients, those on a morning dose of modafinil (400 mg) for 8 weeks had significantly more BE-negative urine samples (p=0.03) compared to placebos, and were more likely to achieve a protracted period (> or =3 weeks) of cocaine abstinence (p=0.05). All patients also received manual-guided, twice-weekly cognitive behavioral therapy.  A double-blind, placebo-controlled trial of modafinil for cocaine dependence. Dackis CA, et al. University of Pennsylvania. Neuropsychopharmacology. 2005 Jan;30(1):205-11. Ed: Other stimulants may also have helped in the treatment of cocaine abuse.  Modafinil is probably less likely to be abused.  Whether there is long-term success is unclear and, even if it helps, there may be a need for the close monitoring and counseling provided in this study.

Naltrexone Helped Some in DB: A 12-week DB PC study of 50 mg/d naltrexone or placebo with or without counseling found fewer positive urines with naltrexone but no difference in retention or in time to first cocaine use between the four groups. Authors comment favorably about coping skills training.  Naltrexone and relapse prevention treatment for cocaine-dependent patients. Schmitz JM, Stotts AL, Rhoades HM, Grabowski J. Addict Behav. 2001 Mar-Apr;26(2):167-80

Disulfiram Helped in DB: A 12-week DB PC study of 67 cocaine dependents without alcohol abuse found that those on disulfiram had fewer dirty urines. Disulfiram inhibits dopamine beta-hydroxylase resulting in an excess of dopamine and decreased synthesis of norepinephrine. Since cocaine is a potent catecholamine re-uptake inhibitor, disulfiram may blunt cocaine craving or alter the "high", resulting in a decreased desire to use cocaine. Alcohol use with minimal in both groups. Yale. Disulfiram treatment for cocaine dependence in methadone-maintained opioid addicts. Petrakis IL, Carroll KM, Nich C, Gordon LT, McCance-Katz EF, Frankforter T, Rounsaville BJ. Addiction. 2000 Feb;95(2):219-28

Disulfiram and Cognitive Behavioral Therapy Helps in Randomized Study: In a study of 121 cocaine-dependent individuals randomly assigned to receive disulfiram or a placebo, in addition to undergoing one of two behavioral therapy interventions, participants received either cognitive behavioral therapy (CBT) or interpersonal psychotherapy (IPT) in individual sessions during the 12-week project. Disulfiram reduced cocaine use significantly compared with placebo. In addition, those who received disulfiram in combination with CBT reduced their cocaine use compared with those who received disulfiram in combination with IPT. Kathleen Carroll, Yale University, Arch Gen Psychiatry 3/2004. About 60 percent of people dependent on cocaine also abuse alcohol. However, disulfiram exerts a direct effect on cocaine use, rather than reducing concurrent alcohol use. Aversive reactions may also occur when patients taking disulfiram use cocaine. In CBT for addiction, patients are urged to avoid situations that lead to drug use and to practice drug refusal skills.

Carbamazepine Helped Only Cocaine Addicts with Affective Disorders: A DB PC study of 139 cocaine dependent patients found a strong trend for benefit in the 57 with affective disorders but no benefit for the others. Carbamazepine in the treatment of cocaine dependence: subtyping by affective disorder. Brady KT, Sonne SC, Malcolm RJ, Randall CL, Dansky BS, Simpson K, Roberts JS, Brondino M. Exp Clin Psychopharmacol. 2002 Aug;10(3):276-85. See below for failures for general cocaine dependence.

Phenytoin Helped in DB: A 12-week 44-patient DB PC study of 300 mg/d found decreases in reported use and in positive urines, as well as lower cravings. U. Minn. Phenytoin in the treatment of cocaine abuse: a double-blind study. Crosby RD, Pearson VL, Eller C, Winegarden T, Graves NL. Clin Pharmacol Ther. 1996 Apr;59(4):458-68

Nicotine Enhances Cocaine Craving: 20 cigarette smoking crack cocaine dependents were studied in a DB crossover trial using nicotine patches. Following exposure to cocaine cues, all patients reported an increase in cocaine craving and anxiety relative to the pre-cue measures. The cue-induced increase in cocaine craving was strongly enhanced by nicotine, while the increase in anxiety was slightly augmented. This occurred in the absence of any tobacco smoking-related cues, suggesting that nicotine may have direct psychopharmacological effects on conditioned cocaine craving. An acute dose of nicotine enhances cue-induced cocaine craving. Reid MS, Mickalian JD, Delucchi KL, Hall SM, Berger SP. Drug Alcohol Depend. 1998 Jan 1;49(2):95-104

Medications Not Helping

Acupuncture for Cocaine Dependence Not Helpful: Acupuncture no more successful than sham or no acupuncture. JAMA 1/2/02;287:55

Amantidine No Value for Opioid or Cocaine Dependence in DB: 80 methadone patients, half cocaine dependent were in two DB PC studies. Barcelona. Methadone tapering plus amantadine to detoxify heroin-dependent inpatients with or without an active cocaine use disorder: two randomised controlled trials. Perez de los Cobos J, Duro P, Trujols J, Tejero A, Batlle F, Ribalta E, Casas M. Drug Alcohol Depend. 2001 Jul 1;63(2):187-95; Similar results in Drug Alcohol Depend. 1996 May;41(1):25-33; and Drug Alcohol Depend. 1995 Oct;39(3):173-80

Amantidine Helped in DB: A 61-patient DB PC study found fewer dirty urines and less reported cocaine abuse. U Penn. Amantadine in the treatment of cocaine-dependent patients with severe withdrawal symptoms. Kampman KM, Volpicelli JR, Alterman AI, Cornish J, O'Brien CP. Am J Psychiatry. 2000 Dec;157(12):2052-4

Bromocriptine No Value in DB: A 24-patient DB PC 6-week trial found no decrease in cravings or dirty urines. The authors note that open trials had been promising. Bromocriptine for cocaine dependence. A controlled clinical trial. Handelsman L, Rosenblum A, Palij M, Magura S, Foote J, Lovejoy M, Stimmel B. Am J Addict. 1997 Winter;6(1):54-64; Same in Am J Drug Alcohol Abuse. 1995 Feb;21(1):65-79

Bupropion No Benefit in DB: A 149-patient, 12 week DB PC Study of 300 mg. bupropion. Yale. A multicenter trial of bupropion for cocaine dependence in methadone-maintained patients. Margolin A, Kosten TR, Avants SK, Wilkins J, Ling W, Beckson M, Arndt IO, Cornish J, Ascher JA, Li SH, et al. Drug Alcohol Depend. 1995 Dec;40(2):125-31

Carbamazepine No Value: Four randomized trials of 272 pts analyzed. High dropouts both carbamazepine (61%) and placebo (69%). No diff presence of urine cocaine metabolites. Anelise Lima, Brazil, 5/17/99 APA; A DB of 82 patients without benefit: Drug Alcohol Depend. 1995 Jun;38(3):221-7; DB of 62 without benefit: Drug Alcohol Depend. 1995 Jun;38(3):213; Similar with 40 patients: Drug Alcohol Depend. 1995 Jun;38(3):203-11

Neither Carbamazepine Nor Desipramine Helped Retention: DB PC 65 addicts. use of desipramine or carbamazepine may not offer any advantage in retaining cocaine-dependent patients in treatment. Impact of desipramine or carbamazepine on patient retention in outpatient cocaine treatment: preliminary findings. Campbell JL, Thomas HM, Gabrielli W, Liskow BI, Powell BJ. J Addict Dis 1994;13(4):191-9

Fluoxetine No Benefit for Depressed Cocaine Addicts: A 12-week, 68 depressed, cocaine-dependent patient, DB PC study of fluoxetine 40 mg/d found no benefit for decreasing cocaine abuse or for treating depression which tended to improve with time in both groups. U Texas-Houston. Fluoxetine treatment of cocaine-dependent patients with major depressive disorder. Schmitz JM, Averill P, Stotts AL, Moeller FG, Rhoades HM, Grabowski J. Drug Alcohol Depend. 2001 Aug 1;63(3):207-14; Similar in two DBs: J Clin Psychopharmacol. 1995 Jun;15(3):163-74

Gabapentin for Craving: 2 patients. One on 200mg imipramine for depression and had gabapentin titrated to 400mg BID with total disappearance of craving. 2^nd schizoaffective on FD. Gabapentin titrated to 1200 bid markedly reduced cravings tho 1 mild relapse. Raby, Am J Psychiatry 00;157:2058

Gabapentin for Craving: 30 patient open-label. 600mg/d increased to 1200/d. 8weeks. Only 6 completed all 8 weeks! Less craving from 1^st week. J Clin Psychaitry 01;62:19. Ed: A useless open trial.  It should never have been published.

Ginkgo No Value and Piracetam Worse than Placebo in DB: 44 cocaine addicts in DB PC. U Penn. A pilot trial of piracetam and ginkgo biloba for the treatment of cocaine dependence. Kampman K, Majewska MD, Tourian K, Dackis C, Cornish J, Poole S, O'Brien C. Addict Behav. 2003 Apr;28(3):437-48

GVG or vigabatrin (Sabril) May Help: An open trial of 20 cocaine addicts given increasing doses had 8 drop out in first week to use cocaine. 8 of the others did well on increasing doses of vigabatrin.  The medicine is an old and infrequently used epileptic medication available in Canada for $1 per 500 mg pill. Stephen Dewey, Brookhaven Natl Lab, Synapse (DOI: 10.1002/syn.10278).(Ed: Open trials are notoriously unreliable)

Ketoconazole No Value for Cocaine or Opioid Dependence in DB: A 12-week DB PC study of 39 patients in methadone maintenance. Yale. Ketoconazole increases cocaine and opioid use in methadone maintained patients. Kosten TR, Oliveto A, Sevarino KA, Gonsai K, Feingold A. Drug Alcohol Depend. 2002 Apr 1;66(2):173-80

Naltrexone-SSRI for Cocaine-Depr-Compulsive Sex Case: 42yo female treated fluoxetine 20 raised to 60/d helped only depression. Naltrexone increased up to 100mg/d stopped sex and drug urges. Trial switch fluox to citalopram due to sedation and low libido led to increase sex urges and decr with incr naltrexone to 150 and return to fluox. Case of 62yo man with dysthymic & masochistic fantasies and extramarital affairs. Multiple SSRIs and nefazodone helped depr somewhat but not sex dysfunction. One month after 50mg/d naltrexone dramatic decr sex symptoms. Recurrence led to 100mg/d and remission. Intern Clin Psychopharm 7/02

Olanzapine Worse than Placebo in DB: 30 cocaine addicts in DB PC U Penn. A pilot trial of olanzapine for the treatment of cocaine dependence. Kampman KM, Pettinati H, Lynch KG, Sparkman T, O'Brien CP. Drug Alcohol Depend. 2003 Jun 5;70(3):265-7

Propranolol No Value in DB: An 8-week, DB PC study of 108 cocaine dependents found no difference in retention or dirty urine although propranolol did mitigate withdrawal symptoms. Those with more severe problems did do better on a separate analysis. U Penn. Effectiveness of propranolol for cocaine dependence treatment may depend on cocaine withdrawal symptom severity. Kampman KM, Volpicelli JR, Mulvaney F, Alterman AI, Cornish J, Gariti P, Cnaan A, Poole S, Muller E, Acosta T, Luce D, O'Brien C. Drug Alcohol Depend. 2001 Jun 1;63(1):69-78

Pergolide Much Worse than Placebo: In a 255-patient DB PC study, the retention rate of the placebo group (49%) was significantly higher than with either low dose or higher dose pergolide (21%). U. South Carolina. Adverse outcomes in a controlled trial of pergolide for cocaine dependence. Malcolm R, Herron J, Sutherland SE, Brady KT. J Addict Dis. 2001;20(1):81-92

Risperidone No Benefit in DB: A 193-patient, 12-week DB PC study of 2-8 mg risperidone found patients didn't like it and there was no decrease in dirty urines. U Texas-Houston. Risperidone for the treatment of cocaine dependence: randomized, double-blind trial. Grabowski J, Rhoades H, Silverman P, Schmitz JM, Stotts A, Creson D, Bailey R. 

Ritanserin No Benefit in DB: A 4-week 80-patient DB PC study of this 5-HT(2) antagonist. U. Penn. A randomized, double-blind, placebo-controlled study of ritanserin pharmacotherapy for cocaine dependence. Cornish JW, Maany I, Fudala PJ, Ehrman RN, Robbins SJ, O'Brien CP. Drug Alcohol Depend. 2001 Jan 1;61(2):183-9; Similar result in Biol Psychiatry. 1997 Nov 15;42(10):932-40

Medical Complications of Cocaine Abuse

Acute Dystonia: Cocaine a Risk Factor: pts using cocaine recently prior to hosp 4.4 times more likely get than 20 control pts. Therefore, prophylactically Rx for at least 7 days with anticholinergic. Peter van Harten, Curacao J Clin Psychiatry 59:128-30.

More Heart Attacks: SUNY Buffalo researchers found ¼ of nonfatal heart attacks for people 18 to 45 are due to cocaine. In a six year study of 10,085, of who m 532 used cocaine regularly, drug users had 7 times more heart attacks. Circulation ?/2001.

Aortic Dissection Common: Death rate 50%, twice as high as normal. Circulation 3/2002

Cocaine Psychosis Common Experience: In a study of 55 adults admitted to a drug program for DSM-III-R cocaine dependence, 53% reported experiencing transient cocaine-induced psychosis. Paranoid delusions were experienced by 90% and 96% had : 83% auditory hallucinations; 38% visual hallucinations; and 21% tactile hallucinations. Cocaine-induced psychosis. Brady KT, Lydiard RB, et al. Medical University of South Carolina. J Clin Psychiatry. 1991 Dec;52(12):509-12.