Desipramine and contingency management for cocaine and opiate dependence in buprenorphine maintained patients
Desipramine and contingency management for cocaine and opiate dependence in buprenorphine maintained patients
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DOI：
10.1016/s0376-8716(03)00032-2
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发表时间：
2003-06-05
影响因子：
4.2
通讯作者：
Gonsai, K
中科院分区：
文献类型：
--
作者：
Kosten, T;Oliveto, A;Gonsai, K
在接受美沙酮治疗的患者中，约60%的患者对阿片类药物和可卡因产生共同依赖，预后不良。然而，我们最近发现，地昔帕明（地昔帕明）可以与丁丙诺啡联合使用，以显着减少这些双重依赖患者中阿片类药物和可卡因的联合使用。此外，应急管理（CM）在减少美沙酮维持治疗期间可卡因滥用方面相当有效。为了测试CM与这些药物联合使用的疗效，我们设计了一项为期12周的随机、双盲、四细胞试验，在160名可卡因滥用者中评估了丁丙诺啡（中位数为16 mg/天）或安慰剂加CM或非偶然凭证对照。无可卡因和联合阿片类药物和无可卡因的尿液增加更快，随着时间的推移，在接受任何一种药物或CM，和那些接受两种干预措施有更多的无药物尿液（50%）比其他三个治疗组（25-29%）。自我报告的阿片类药物和可卡因使用以及抑郁和阿片类药物戒断症状在各组之间没有差异，症状水平与尿液毒理学结果无关。较低的可卡因血浆水平（平均125 ng/ml）与较高的无可卡因尿液相关。在丁丙诺啡维持治疗的患者中，利多卡因和CM在促进无可卡因尿液方面具有独立和相加作用。抗抑郁药似乎增强了对CM强化的反应性。(C)2003爱思唯尔科学爱尔兰有限公司保留所有权利。
Co-dependence on opiates and cocaine occurs in about 60% of patients entering methadone treatment and has a poor prognosis. However, we recently found that desipramine (DMI) could be combined with buprenorphine to significantly reduce combined opiate and cocaine use among these dually dependent patients. Furthermore, contingency management (CM) has been quite potent in reducing cocaine abuse during methadone maintenance. To test the efficacy of combining CM with these medications we designed a 12-week, randomized, double blind, four cell trial evaluating DMI (150 mg/day) or placebo plus CM or a non-contingent voucher control in 160 cocaine abusers maintained on buprenorphine (median 16 mg daily). Cocaine-free and combined opiate and cocaine-free urines increased more rapidly over time in those treated with either DMI or CM, and those receiving both interventions had more drug-free urines (50%) than the other three treatment groups (25-29%). Self reported opiate and cocaine use and depressive and opioid withdrawal symptoms showed no differences among the groups and symptom levels did not correlate with urine toxicology results. Lower DMI plasma levels (average 125 ng/ml) were associated with greater cocaine-free urines. DMI and CM had independent and additive effects in facilitating cocaine-free urines in buprenorphine maintained patients. The antidepressant appeared to enhance responsiveness to CM reinforcement. (C) 2003 Elsevier Science Ireland Ltd. All rights reserved.