title: Effects of biperiden on the treatment of cocaine/crack addiction: a randomised, double-blind, placebo-controlled trial.
abstract: Cocaine use affects approximately 13.4 million people, or 0.3% of the world's population between 15 and 64 years of age. Several authors have described drug addiction as a disease of the brain reward system. Given that the cholinergic system impacts reward mechanisms and drug self-administration, acetylcholine (ACh) might play an important role in the cocaine addiction process. We evaluated the efficacy of biperiden (a cholinergic antagonist) in reducing craving and the amount used, and in increasing compliance with treatment for cocaine/crack addiction. It was a study double-blind, randomised, placebo-controlled, 8-week trial of 111 cocaine or crack addicted male patients between 18 and 50 years old. Two groups were compared: placebo (n=55) or biperiden (n=56) combined with weekly sessions of brief group cognitive-behavioural therapy. The efficacy of treatment was evaluated according to the patients' compliance and several instruments: the Minnesota Cocaine Craving Scale, the Beck Depression and Anxiety Scales and a questionnaire assessing the amount of drug used. All of the patients attended weekly sessions for two months. We analysed the data considering the patients' intention to treat based on our last observation. Of the 56 patients in the biperiden group, 24 completed the treatment (42.8%) compared with only 11 patients in the placebo group (20%), which was a significant difference (p=0.009). Compliance with treatment was 118% higher in the biperiden group, which was also the group that presented a statistically significant reduction in the amount of cocaine/crack use (p<0.001). There was statistically significant difference between the craving score in the biperiden group. Pharmacological blockade of the cholinergic system with biperiden is a promising alternative to treat cocaine/crack addiction, helping patients to reduce the amount used and improving compliance with psychotherapy treatment.
authors: Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.
authors: Luiz Henrique Junqueira
authors: LH
authors: Dieckmann
authors: Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.
authors: Anna Carolina
authors: AC
authors: Ramos
authors: Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.
authors: Eroy Aparecida
authors: EA
authors: Silva
authors: Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.
authors: Luis Pereira
authors: LP
authors: Justo
authors: Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.
authors: Pamela
authors: P
authors: Sabioni
authors: Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.
authors: Iracema Francisco
authors: IF
authors: Frade
authors: Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil.
authors: Altay Lino
authors: AL
authors: de Souza
authors: Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, Brazil. Electronic address: galduroz@unifesp.br.
authors: José Carlos Fernandes
authors: JC
authors: Galduróz
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001712:Biperiden / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D019970:Cocaine-Related Disorders / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome
chemical_list: D018727:Muscarinic Antagonists; D001712:Biperiden
keywords: Biperiden; Cholinergic antagonist; Cocaine; Crack; Craving; Treatment