Medication May Help Treat Cocaine Addiction For The First Time.


Photo credit: Drug Enforcement Administration

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There are no current FDA-approved medications for cocaine addiction, but that might be about to change. A new study published in JAMA Psychiatry from researchers at University of Virginia’s Department of Psychiatry and Neurobehavioral Sciences has shown that cocaine dependence can be treated with the repurposed medication topiramate.

Topiramate (trade name Topamax) is an anticonvulsant that has been used to treat a variety of conditions, such as seizures associated with epilepsy and Lennox-Gastaut syndrome, bipolar disorder, alcohol dependance, and migraine prevention.

The double-blind study consisted of 142 individuals addicted to cocaine. Half of the group was randomly assigned to receive topiramate while the other half was given a placebo. Over the course of the 12 weeks for the study, the topiramate group reported significantly more cocaine-free days which indicate the likelihood of cocaine-free weeks. Additionally, the topiramate group reported fewer cravings and increased functioning when compared to the placebo group.

Side effects were mild and minimal, including inattentiveness, skin tingling, taste distortions, and decreased appetite. High doses of topiramate have been associated with glaucoma, though that was not a factor in this study. Ultimately, the results of the study suggest that topiramate is a safe and effective drug for combatting cocaine dependence.

Because topiramate has been shown to be effective in cocaine and alcohol addictions, head researcher Bankole A. Johnson is optimistic that understanding how the chemicals interact with the brain could help scientists understand the neurobiological cause of addiction.

Cocaine, a derivative of the South American coca plant, causes more emergency room visits than any other illegal substance. Cocaine is an intense stimulator of the central nervous system and affects the circulatory system by increasing heart rate while constricting blood vessels. Cocaine use can lead to stroke or cardiac arrest, which may cause death.

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NEW STUDY SHOWS PROMISE FOR FIRST EFFECTIVE MEDICINE TO TREAT COCAINE DEPENDENCE.


Professor Bankole A. Johnson, Chairman of Psychiatry at the University of Maryland School of Medicine, Reports Latest Findings on the Anti-epileptic Drug, Topiramate

New research published in JAMA Psychiatry reveals that topiramate, a drug approved by the U.S. Food and Drug Administration (FDA) to treat epilepsy and migraine headaches, also could be the first reliable medication to help treat cocaine dependence. The study, led by Bankole A. Johnson, DSc. MD., MB.ChB., MPhil., chairman of the Department of Psychiatry at the University of Maryland School of Medicine and head of the School’s new Brain Science Research Consortium Unit, with support from the National Institutes of Health and Agency for Healthcare Research and Quality, is one of the first to establish a pharmacological treatment for cocaine addiction, for which there are currently no FDA-approved medications.

Addiction affects 13.2 to 19.7 million cocaine users worldwide. Cocaine is responsible for more U.S. emergency room visits than any other illegal drug. Cocaine harms the brain, heart, blood vessels, and lungs — and can even cause sudden death. Professor Johnson, one of the nation’s leading neuroscientists and psychopharmacologists, had previously found that topiramate was a safe and effective treatment for alcohol dependence compared with placebo.

In releasing the new study, Professor Johnson, who conducted the research when he was with Department of Psychiatry and Neurobehavioral Sciences at the University of Virginia, provided full disclosures, which follow the text of this news announcement.* The study enrolled 142 participants, aged 18 years or older, seeking treatment for cocaine dependence. Following enrollment, participants were randomly assigned into a topiramate group or placebo group. Neither the participants nor the healthcare professionals administering the treatment knew who was in which group (double-blinded study).

Using an intent-to-treat analysis, the researchers found that topiramate was more efficacious than placebo at increasing the participants’ weekly proportion of cocaine nonuse days and in increasing the likelihood that participants would have cocaine-free weeks. Furthermore, compared with placebo, topiramate also was significantly associated with a decrease in craving for cocaine and an improvement in participants’ global functioning.

The study investigators also observed few side effects due to drug treatment. In general, participants in the topiramate group experienced mild side-effects, including abnormal tingling skin sensations, taste distortions, anorexia, and difficulty concentrating.

“Our findings reveal that topiramate is a safe and robustly efficacious medicine for the treatment of cocaine dependence, and has the potential to make a major contribution to the global health crisis of addiction,” Professor Johnson said. “However, topiramate treatment also is associated with glaucoma, and higher doses of the drug can increase the risk of side effects; therefore, caution must be exercised when prescribing the drug, especially when given in high doses.” These results build upon earlier work from Professor. Johnson’s group which indicated that individuals dependent on cocaine, but not seeking treatment, who took topiramate were more likely to experience reduced cravings and preference for cocaine, compared with placebo. The findings of the current study indicate that topiramate may be even more effective in treating people with addiction who actively want to quit using cocaine.

“Because topiramate is the first medication to demonstrate a robust therapeutic effect for the treatment of cocaine or alcohol dependence, its fundamental neurochemical effects provide important clues as to common links in the neurobiological basis of the addictive process in general,” remarked Professor Johnson. “These findings also add to our understanding of how addiction affects the brain because it demonstrates the unique concept that dual neurotransmitter modulation, by simultaneously augmenting the inhibitory action of gamma amino butyric acid and inhibiting the excitatory effects of glutamate, can result in therapeutic effects that reduce the propensity to use cocaine.”

The skinny on cocaine. Insights into eating behavior and body weight in cocaine-dependent men.


Abstract

There is a general assumption that weight loss associated with cocaine use reflects its appetite suppressing properties. We sought to determine whether this was justified by characterizing, in detail, alterations in dietary food intake and body composition in actively using cocaine-dependent individuals. We conducted a cross-sectional case-control comparison of 65 male volunteers from the local community, half of whom satisfied the DSM-IV-TR criteria for cocaine dependence (n = 35) while the other half had no personal or family history of a psychiatric disorder, including substance abuse (n = 30). Assessments were made of eating behavior and dietary food intake, estimation of body composition, and measurement of plasma leptin. Although cocaine users reported significantly higher levels of dietary fat and carbohydrates as well as patterns of uncontrolled eating, their fat mass was significantly reduced compared with their non-drug using peers. Levels of leptin were associated with fat mass, and with the duration of stimulant use. Tobacco smoking status or concomitant use of medication did not affect the significance of the results. Weight changes in cocaine users reflect fundamental perturbations in fat regulation. These are likely to be overlooked in clinical practice but may produce significant health problems when cocaine use is discontinued during recovery.