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， 可卡因和阿片类药物滥用的临床试验。 结果 我们部门最近完成的一项临床试验不支持 卡马西平治疗可卡因依赖的效用。 一 一项双盲、安慰剂对照临床试验已完成测试 可卡因依赖者中的卡马西平。 结局指标为 可卡因阴性尿样，自我报告的药物使用，和自我报告的 报告说对可卡因有渴望 无显著差异 随机分配至安慰剂组或卡马西平组的受试者之间 治疗组的任何主要结局指标。 的 对可卡因依赖者使用卡马西平是安全的 在测试的剂量下。 临床前研究的证据表明， 与其抑制多巴胺再摄取有关。 大部分 开发可卡因依赖药物治疗的工作 迄今为止集中于多巴胺能药物，尽管没有多巴胺能药物 尚未证明对减少可卡因使用有效。 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， 目前正在进行中，到目前为止， 治疗对象。 本研究首次采用了 联合药物以增加个体的功效 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。 一个双- 目前正在进行盲法对照临床试验， 丁丙诺啡在减少阿片剂和可卡因使用方面疗效 阿片类药物和可卡因双重依赖患者。 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 正在开发治疗方法，以提供更有效的戒断后 治疗 丁丙诺啡/纳曲酮组合的疗效如下 正在进行临床试验

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.