Desipramine and contingency management for cocaine and opiate dependence in buprenorphine maintained patients.
Co-dependence on opiates and cocaine occurs in about 60% of patients entering methadone treatment and has a poor prognosis. However, we recently found that desipramine (DMI) could be combined with buprenorphine to significantly reduce combined opiate and cocaine use among these dually dependent patients. Furthermore, contingency management (CM) has been quite potent in reducing cocaine abuse during methadone maintenance. To test the efficacy of combining CM with these medications we designed a 12-week, randomized, double blind, four cell trial evaluating DMI (150 mg/day) or placebo plus CM or a non-contingent voucher control in 160 cocaine abusers maintained on buprenorphine (median 16 mg daily). Cocaine-free and combined opiate and cocaine-free urines increased more rapidly over time in those treated with either DMI or CM, and those receiving both interventions had more drug-free urines (50%) than the other three treatment groups (25-29%). Self reported opiate and cocaine use and depressive and opioid withdrawal symptoms showed no differences among the groups and symptom levels did not correlate with urine toxicology results. Lower DMI plasma levels (average 125 ng/ml) were associated with greater cocaine-free urines. DMI and CM had independent and additive effects in facilitating cocaine-free urines in buprenorphine maintained patients. The antidepressant appeared to enhance responsiveness to CM reinforcement.
Kosten
Thomas
T
Department of Psychiatry, Yale University School of Medicine, VA New England MIRECC, VA Caonnecticut Healthcare System, 950 Campbell Avenue, Bldg. 35, West Haven, CT 06516, USA. thomas.kosten@yale.edu
Oliveto
Alison
A
Feingold
Alan
A
Poling
James
J
Sevarino
Kevin
K
McCance-Katz
Elinore
E
Stine
Susan
S
Gonzalez
Gerardo
G
Gonsai
Kishor
K
D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D000704:Analysis of Variance; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D002047:Buprenorphine / Q000627:therapeutic use*; D019970:Cocaine-Related Disorders / Q000188:drug therapy* / Q000652:urine; D003237:Connecticut; D003891:Desipramine / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009294:Narcotics; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000652:urine; D016896:Treatment Outcome
D000929:Antidepressive Agents, Tricyclic; D009294:Narcotics; D002047:Buprenorphine; D003891:Desipramine