The principles of agonist pharmacotherapy for psychostimulant dependence.
OBJECTIVE
Psychostimulant dependence is a chronic, relapsing condition which is highly treatment refractory. No medications to date have been any more successful than placebo in reducing psychostimulant use in dependent patients. Agonist strategies have attracted limited attention.


METHODS
Successful examples of agonist pharmacotherapy in the treatment of heroin and nicotine dependence are first considered. Agonist pharmacological approaches to the treatment of psychostimulant dependence are then examined, based on the dopamine receptor agonist and indirect dopamine agonist strategies. Finally, the potential extension of the concept of agonist pharmacotherapy to include the novel non-amphetamine-type stimulant, modafinil, is discussed.


CONCLUSIONS
Agonist approaches appear to be viable with risks outweighed by benefits in carefully selected, monitored and motivated patients. On the other hand, the effectiveness of indirect agonists such as dexamphetamine and methylphenidate are not established. Further research is required to determine optimal treatment models (whether maintenance or withdrawal), effective safe dosages and duration (short or long term).
Shearer
James
J
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia. j.shearer@med.unsw.edu.au
D001559:Benzhydryl Compounds / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D000697:Central Nervous System Stimulants / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D018491:Dopamine Agonists / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D006556:Heroin Dependence / Q000534:rehabilitation; D006801:Humans; D000077408:Modafinil; D016032:Randomized Controlled Trials as Topic; D013375:Substance Withdrawal Syndrome / Q000534:rehabilitation*; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D014029:Tobacco Use Disorder / Q000534:rehabilitation
D001559:Benzhydryl Compounds; D000697:Central Nervous System Stimulants; D018491:Dopamine Agonists; D000077408:Modafinil