EVALUATION OF PHARMACOLOGIC TREATMENTS OF OPIATE AND COCAINE DEPENDENCE

这个项目评估了药物的安全性和有效性。 临床试验中可卡因和阿片类药物滥用/依赖的治疗。 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。一个 双盲对照临床试验，直接评估 丁丙诺啡减少阿片类药物和可卡因使用200例疗效观察 阿片类药物和可卡因依赖的双重治疗在过去已经完成 年。初步分析表明，丁丙诺啡降低了 可卡因和阿片类药物的使用(根据尿液分析)，最高剂量 与较低剂量相比，可卡因使用量减少的程度更大。 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 开发的治疗方法是在戒断后提供更有效的 包括阿片类药物治疗在内的治疗 对抗者。丁丙诺啡-纳曲酮联合用药的疗效 已在一项试验和一项随机双盲临床试验中进行测试 审判。第二项研究的结果与最初的试验结果相同 研究表明，纳曲酮在第二天的服药量可能会增加 在治疗开始时停用阿片类药物，但通常是安全的 有效。研究的第三阶段正在进行中，以进一步完善 丁丙诺啡/纳曲酮给药参数以确定最佳程序 开始纳曲酮治疗。 上述研究的初步分析表明， 丁丙诺啡治疗阿片依赖安全有效 在HIV阳性患者身上。目前正在进行一项研究，以比较 丁丙诺啡、可乐定和美沙酮在阿片类药物治疗中的应用 因艾滋病毒相关疾病住院的患者的依赖性。 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。一场公开的 联合治疗的安全性和有效性的试验测试 安非他酮和溴隐亭，具有多巴胺能活性的药物，已经被 完成。在接受治疗的患者中，副作用发生率较低。 受试者中，自我报告的可卡因使用和 渴望。到目前为止收集的数据表明，这种组合是安全的。 可能对治疗可卡因依赖有效。

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.