EVALUATION OF PHARMACOLOGIC TREATMENTS OF OPIATE AND COCAINE DEPENDENCE

该项目评估了药物的安全性和有效性， 在临床试验中治疗可卡因和阿片类药物滥用/依赖。 部分阿片激动剂丁丙诺啡是一种安全有效的 治疗阿片类药物依赖 一些临床前研究和 非对照临床病例系列表明，丁丙诺啡可能 还可有效减少鸦片成瘾者使用可卡因。 一 双盲对照临床试验，直接评估 丁丙诺啡在减少200例阿片类药物和可卡因使用方面的疗效 阿片类药物和可卡因双重依赖的患者在过去完成 年 初步分析表明，丁丙诺啡降低了 可卡因和阿片类药物使用（基于尿液分析）， 可卡因的使用量比低剂量减少得更多。 在医学监督下戒断阿片类药物是一种常用的治疗方法 但通常不能有效地建立长期禁欲， 患者经常在完成停药后不久复发。 一 停药期间开始纳洛酮维持治疗的程序 开发了治疗方法，以提供更有效的戒断后 包括阿片类药物治疗的治疗 对手。 丁丙诺啡-纳洛酮组合的功效 在一个试点和一个随机双盲临床试验中进行了测试 审判 第二项研究的结果复制了最初的试点 研究表明，在第2天给予纳洛酮可能会增加 在治疗开始时戒断阿片类药物，但通常是安全的， 有效 目前正在进行第三阶段的研究，以进一步完善 确定最佳程序的丁丙诺啡/纳洛酮给药参数 开始纳洛酮治疗 对上述研究的初步分析表明， 丁丙诺啡治疗阿片类药物依赖安全有效 艾滋病病毒阳性患者。 目前正在进行一项研究， 丁丙诺啡、可乐定和美沙酮在阿片类药物治疗中的应用 艾滋病毒相关疾病住院患者的依赖性。 临床前研究的证据表明， 与其抑制多巴胺再摄取有关。 一个开放 联合治疗的安全性和有效性试验 安非他酮和溴隐亭是具有多巴胺能活性的药物， 完成 在接受治疗的患者中， 受试者，自我报告的可卡因使用减少， 渴望 迄今为止收集的数据表明，这种组合是安全的 并且可能有效治疗可卡因依赖。

This project assesses the safety and efficacy of pharmacological treatments of cocaine and opioid abuse/dependence in clinical trials. 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 that directly evaluated the efficacy of buprenorphine in reducing both opiate and cocaine use in 200 dually opiate- and cocaine-dependent patients was completed in the past year. Preliminary analyses indicated that buprenorphine decreased both cocaine and opiate use (based on urinalysis) and that the highest dose decreased cocaine use to a greater degree than the lower doses. 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 was developed to provide a more effective post-withdrawal treatment that includes pharmacological treatment with opioid antagonists. The efficacy of buprenorphine-naltrexone combinations has been tested in a one pilot and one randomized double-blind clinical trials. The results of the second study replicated the original pilot study showing that administration of naltrexone on day 2 may increase opiate withdrawal at the beginning of treatment but is generally safe and effective. A third phase of the study is ongoing to further refine the buprenorphine/naltrexone dosing parameters to identify optimal procedures for initiating naltrexone treatment. Preliminary analysis of the studies described above suggest that buprenorphine is safe and effective for treatment of opioid dependence in HIV-positive patients. A study is currently underway to compare buprenorphine, clonidine, and methadone in the management of opioid dependence in patients hospitalized for HIV-related illnesses. Evidence from preclinical studies suggests that the reinforcing effects of cocaine are related to its inhibition of dopamine reuptake. An open trial testing the safety and efficacy of combination treatment with bupropion and bromocriptine, agents with dopaminergic activity, has been completed. There was a low incidence of side effects among treated subjects, and there was a decrease in self-reported cocaine use and craving. Data collected to date suggest that this combination is safe and possibly effective for treatment of cocaine dependence.