|Titre :||Pharmacotherapeutic strategies for treating cocaine use disorder - What do we have to offer? [Addiction Opinion and Debate] (2021)|
|Auteurs :||L. BRANDT ; T. CHAO ; S. D. COMER ; F. R. LEVIN|
|Type de document :||Article : Périodique|
|Dans :||Addiction (Vol.116, n°4, April 2021)|
|Article en page(s) :||694-710|
|Note générale :||
- When the evidence is not enough: is it time to rethink trial design? McKetin R., Farrell M., p. 711-712.
- Will hope triumph over experience in pharmacotherapy research on cocaine use disorder? Humphreys K., p. 712-714.
- If there were an effective pharmacotherapy for cocaine use disorder, what would it do? Shoptaw S., Trivedi M., Potter J.S., p. 714-715.
- How can we optimally channel therapeutic optimism to advance pharmacotherapy research on cocaine use disorder? Brandt L., Chao T., Comer S.D., Levin F.R., p. 715-717.
|Discipline :||TRA (Traitement et prise en charge / Treatment and care)|
Thésaurus TOXIBASECOCAINE ; PHARMACOTHERAPIE ; TRAITEMENT ; MECANISME D'ACTION ; DOPAMINE ; AGONISTE ; VACCINATION ; RECHERCHE
BACKGROUND: Cocaine use continues to be a significant public health problem world-wide. However, despite substantial research efforts, no pharmacotherapies are approved for the treatment of cocaine use disorder (CUD).
ARGUMENT: Studies have identified positive signals for a range of medications for treating CUD. These include long-acting amphetamine formulations, modafinil, topiramate, doxazosin and combined topiramate and mixed amphetamine salts extended-release (MAS-ER). However, valid conclusions about a medication's clinical efficacy require nuanced approaches that take into account behavioural phenotypes of the target population (frequency of use, co-abuse of cocaine and other substances, genetic subgroups, psychiatric comorbidity), variables related to the medication (dose, short-/long-acting formulations, titration speed, medication adherence) and other factors that may affect treatment outcomes. Meta-analyses frequently do not account for these co-varying factors, which contributes to a somewhat nihilistic view on pharmacotherapeutic options for CUD. In addition, the predominant focus on abstinence, which is difficult for most patients to achieve, may overshadow more nuanced therapeutic signals.
CONCLUSION: While there is an emphasis on finding new medications with novel mechanisms of action for treating CUD, currently available medications deserve further investigation based on the existing literature. Evaluating refined metrics of treatment success in well-defined subgroups of patients, and further exploring combination therapies and their synergy with behavioural/psychosocial interventions, are promising avenues to establishing effective therapies for CUD.
|Domaine :||Drogues illicites / Illicit drugs|
|Sous-type de document :||Revue de la littérature / Literature review|
|Refs biblio. :||149|
Division on Substance Use Disorders, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
Department of Psychology, The New School for Social Research, New York, NY, USA