Pharmacological treatment of cocaine use disorder: results of three RCTs

                                                                                                                                 Wim van den BRINK - Amsterdam - Hollande

Substance use disorders are generally regarded as brain disorders and the improved understanding of the neurobiology has made it possible to develop effective biological treatments, including pharmacotherapy and different types of neuromodulation, including transcranial magnetic stimulation and deep brain stimulation. However, no proven-effective and registered biological treatment are currently available for patients with a cocaine use disorder. In this presentation I will summarize the results of three randomized controlled trials (RCTs) that were recently conducted by our group in The Netherlands. First, in the RCT (N=74) with 12 weeks topiramate (200mg/day) versus placebo, no indication of success was identified, despite some previous positive findings in the literature. In the discussion I will try to explain the possible reasons for this inconsistency. Second, in the RCT (N=65) with 12 weeks modafinil (400mg/day) versus placebo, some indication for success was observed in treatment adherent patients. Finally, in the RCT (N=73) with 12 weeks sustained- release dexamphetamine (60mg/day) versus placebo in comorbid cocaine use disorder patients currently in heroin assisted treatment (HAT) very positive results were found in terms of both self-reported and urine based reductions in cocaine use. In the discussion of these findings, special attention will be given to the possible reasons for these different findings with these different compounds and the context of these RCTs