Randomized, double blind, placebo-controlled trial of disulfiram for the treatment of cocaine dependence in methadone-stabilized patients.
This study examined the dose-related efficacy of disulfiram for treating cocaine dependence in methadone-stabilized cocaine dependent participants.


METHODS
One hundred and sixty-one cocaine- and opioid-dependent volunteers were entered into a 14-week, double blind, randomized, placebo-controlled clinical trial at two sites.


METHODS
Participants were stabilized on methadone during weeks 1-2 and received disulfiram at 0, 62.5, 125 or 250 mg/day during weeks 3-14. All participants also received weekly cognitive behavioral therapy. Thrice-weekly urine samples and weekly self-reported drug use assessments were obtained.


RESULTS
Baseline subject characteristics, retention and drug use did not differ across groups. Outcome analyses were performed on those who participated beyond week 2. Opioid-positive urine samples and self-reported opioid use did not differ by treatment group. The prevalence of alcohol use was low prior to and during the trial and did not differ by treatment group. Cocaine-positive urines increased over time in the 62.5 and 125 mg disulfiram groups and decreased over time in the 250 mg disulfiram and placebo groups (p < 0.0001). Self-reported cocaine use increased in the 125 mg disulfiram group relative to the other three treatment groups (p = 0.04).


CONCLUSIONS
Disulfiram may be contraindicated for cocaine dependence at doses <250 mg/day. Whether disulfiram at higher doses is efficacious in reducing cocaine use in dually cocaine and opioid dependent individuals needs to be determined.
Oliveto
Alison
A
Psychiatry Dept, University of Arkansas for Medical Sciences, Slot 843, 4301 W Markham St, Little Rock, AR 72205, USA. olivetoalison@uams.edu
Poling
James
J
Mancino
Michael J
MJ
Feldman
Zachary
Z
Cubells
Joseph F
JF
Pruzinsky
Rhonda
R
Gonsai
Kishorchandra
K
Cargile
Christopher
C
Sofuoglu
Mehmet
M
Chopra
Mohit P
MP
Gonzalez-Haddad
Gerardo
G
Carroll
Kathleen M
KM
Kosten
Thomas R
TR
D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D003042:Cocaine / Q000652:urine; D019970:Cocaine-Related Disorders / Q000188:drug therapy* / Q000628:therapy / Q000652:urine; D015928:Cognitive Behavioral Therapy; D004221:Disulfiram / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000628:therapy / Q000652:urine; D057566:Self Report
D003042:Cocaine; D004221:Disulfiram; D008691:Methadone