Disulfiram treatment for cocaine dependence in methadone-maintained opioid addicts.
OBJECTIVE
Cocaine use by patients on methadone maintenance treatment is a widespread problem and is associated with a poorer prognosis. Recent studies have evaluated disulfiram as a treatment for individuals with comorbid alcohol and cocaine abuse. We evaluated the efficacy of disulfiram for cocaine dependence, both with and without co-morbid alcohol abuse, in a group of methadone-maintained opioid addicts.


METHODS
Randomized double-blind, placebo-controlled trial.


METHODS
Urban methadone maintenance clinic.


METHODS
Sixty-seven cocaine-dependent, methadone-maintained, opioid-dependent subjects (52% female; 51% Caucasian).


METHODS
Study medication, either disulfiram or placebo, was placed directly in the methadone to ensure compliance for 12 weeks.


METHODS
Primary outcome measures included weekly assessments of the frequency and quantity of drug and alcohol use, weekly urine toxicology screens and breathalyzer readings.


RESULTS
Disulfiram treated subjects decreased the quantity and frequency of cocaine use significantly more than those treated with placebo. Alcohol use was minimal for all subjects regardless of the medication.


CONCLUSIONS
Disulfiram may be an effective pharmacotherapy for cocaine abuse among methadone-maintained opioid addicts, even in those individuals without co-morbid alcohol abuse. Disulfiram inhibits dopamine beta-hydroxylase resulting in an excess of dopamine and decreased synthesis of norepinephrine. Since cocaine is a potent catecholamine re-uptake inhibitor, disulfiram may blunt cocaine craving or alter the "high", resulting in a decreased desire to use cocaine.
Petrakis
I L
IL
Department of Psychiatry, Yale University, New Haven, Connecticut, USA. PETRAKIS.ISMENE_L+@WEST-HAVEN.GOV
Carroll
K M
KM
Nich
C
C
Gordon
L T
LT
McCance-Katz
E F
EF
Frankforter
T
T
Rounsaville
B J
BJ
D019970:Cocaine-Related Disorders / Q000150:complications / Q000188:drug therapy*; D004221:Disulfiram / Q000627:therapeutic use*; D004311:Double-Blind Method; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000150:complications* / Q000534:rehabilitation
D004791:Enzyme Inhibitors; D009294:Narcotics; D004221:Disulfiram; D008691:Methadone