EVALUATION OF PHARMACOLOGIC TREATMENTS OF OPIATE AND COCAINE DEPENDENCE

阿片剂和可卡因依赖的药理学治疗评估

• 批准号: 3775038
• 负责人: K L PRESTON
• 金额: --
• 依托单位: NATIONAL INSTITUTE ON DRUG ABUSE
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/3775038
• 关键词: bromocriptine; buprenorphine; carbamazepine; clinical trials; cocaine; combination chemotherapy; dopamine agonists; drug abuse chemotherapy; drug addiction; drug withdrawal; human subject; human therapy evaluation; naltrexone; opiate alkaloid

This project assesses the safety and efficacy of pharmacological treatments of cocaine and opioid abuse in clinical trials. Findings of a clinical trial recently completed in our section do not support the utility of carbamazepine in the treatment of cocaine dependence. A double-blind, placebo-controlled clinical trial was completed testing carbamazepine in cocaine dependent subjects. Outcome measures were persent cocaine-negative urine samples, self-reported drug use, and self- reported craving for cocaine. There were no significant differences between subjects randomly assigned to the placebo or carbamazepine treatment groups on any of the primary outcome measures. The administration of carbamazepine to cocaine dependent individuals was safe at the dose tested. Evidence from preclinical studies suggests that the reinforcing effects of cocaine are related to its inhibition of dopamine reuptake. Much of the work to develop pharmacological treatments of cocaine dependence has thus far focused on dopaminergic agents, though no dopaminergic agents have yet been shown to be effective in reducing cocaine use. An open trial testing the safety and efficacy of combination treatment with buproprion and bromocriptine, agents with dopaminergic activity, is underway and has so far shown a low incidence of side effects among treated subjects. This study is the first to apply the strategy of combining pharmacologic agents to increase the efficacy of individual agents in the treatment of cocaine dependence. The partial opiate agonist buprenorphine is a safe and effective treatment for opiate dependence. Some preclinical studies and uncontrolled clinical case series have suggested that buprenorphine might also be effective in reducing cocaine use by opiate addicts. A double- blind, controlled clinical trial is underway that directly evaluates the efficacy of buprenorphine in reducing both opiate and cocaine use in dually opiate- and cocaine-dependent patients. Medically supervised withdrawal from opioids is a commonly used treatment but is usually not effective in establishing long-term abstinence because patients frequently relapse soon after completion of the withdrawal. A procedure for initiating naltrexone maintenance during withdrawal treatment is being developed to provide a more effective post-withdrawal treatment. The efficacy of buprenorphine/naltrexone combinations are being tested in a clinical trial.

这个项目评估了药物的安全性和有效性。 临床试验中的可卡因和阿片类药物滥用治疗。调查结果： 我们部门最近完成的一项临床试验不支持 卡马西平在可卡因依赖治疗中的应用。一个 双盲、安慰剂对照临床试验完成测试 卡马西平在可卡因依赖者中的应用。结果衡量标准是 可卡因阴性的尿样，自我报告的药物使用情况，以及自我 据报道，他对可卡因有渴望。两组间无显著差异 随机分配给安慰剂或卡马西平的受试者之间 治疗组在任何主要结果指标上。这个 卡马西平用于可卡因依赖者是安全的 在测试的剂量。 来自临床前研究的证据表明，强化作用 可卡因的产生与其抑制多巴胺再摄取有关。大部分 开发可卡因依赖的药物治疗方法的工作已经 到目前为止，尽管没有多巴胺能药物，但主要集中在多巴胺能药物上 已被证明在减少可卡因使用方面有效。一场公开的 联合治疗的安全性和有效性的试验测试 具有多巴胺能活性的药物布维酮和溴隐亭是 正在进行中，到目前为止，在以下人群中副作用发生率较低 接受治疗的受试者。这项研究是第一次将 联合用药提高个体疗效 治疗可卡因依赖的药物。 部分阿片激动剂丁丙诺啡是一种安全有效的 治疗鸦片类药物依赖。一些临床前研究和 未控制的临床病例系列表明丁丙诺啡可能 也能有效地减少鸦片成瘾者的可卡因使用。双人间- 正在进行盲法对照临床试验，直接评估 丁丙诺啡在减少阿片类和可卡因使用中的作用 双重鸦片和可卡因依赖患者。 在医学监督下停用阿片类药物是一种常用的治疗方法。 但在建立长期禁欲方面通常并不有效，因为 患者在完成停药后不久经常复发。一个 停药期间启动纳曲酮维持的程序 正在开发治疗方法，以提供更有效的戒断后 治疗。丁丙诺啡/纳曲酮联合应用的疗效如下 在临床试验中进行测试。