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Cited by 150Substance Abuse Treatment and OutcomesOpioid Use Disorder TreatmentNeurotransmitter Receptor Influence on Behavior

Pharmacotherapy for Cocaine Use Disorder—a Systematic Review and Meta-analysis

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Chan, Brian, Kondo, Karli, Freeman, Michele, Ayers, Chelsea, Montgomery, Jessica, Kansagara, Devan·2019·Journal of General Internal Medicine
DOI 10.1007/s11606-019-05074-8PMC PMC6854210
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Abstract

Background Currently, there are no accepted FDA-approved pharmacotherapies for cocaine use disorder, though numerous medications have been tested in clinical trials. We conducted a systematic review and meta-analysis to better understand the effectiveness of pharmacotherapy for cocaine use disorder. Methods We searched multiple data sources (MEDLINE, PsycINFO, and Cochrane Library) through November 2017 for systematic reviews and randomized controlled trials (RCTs) of pharmacological interventions in adults with cocaine use disorder. When possible, we combined the findings of trials with comparable interventions and outcome measures in random-effects meta-analyses. We assessed the risk of bias of individual trials and the strength of evidence for each outcome using standardized criteria. Outcomes included continuous abstinence (3+ consecutive weeks); cocaine use; harms; and study retention. For relapse prevention studies (participants abstinent at baseline), we examined lapse (first cocaine positive or missing UDS) and relapse (two consecutive cocaine positive or missed UDS'). Results Sixty-six different drugs or drug combinations were studied in seven systematic reviews and 48 RCTs that met inclusion criteria. Antidepressants were the most widely studied drug class (38 RCTs) but appear to have no effect on cocaine use or treatment retention. Increased abstinence was found with bupropion (2 RCTs: RR 1.63, 95% CI 1.02 to 2.59), topiramate (2 RCTs: RR 2.56, 95% CI 1.39 to 4.73), and psychostimulants (14 RCTs: RR 1.36, 95% CI 1.05 to 1.77), though the strength of evidence for these findings was low. We found moderate strength of evidence that antipsychotics improved treatment retention (8 RCTs: RR 1.33, 95% CI 1.03 to 1.75). Discussion Most of the pharmacotherapies studied were not effective for treating cocaine use disorder. Bupropion, psychostimulants, and topiramate may improve abstinence, and antipsychotics may improve retention. Contingency management and behavioral interventions along with pharmacotherapy should continue to be explored. Sr registration Prospero CRD42018085667.

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  • The review noted patients with co-occurring OUD may be more likely to benefit from bupropion.

    “The review noted that patients with co-occurring OUD may be more likely to benefit.107,108”

    From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [107]

    The Psychopharmacotherapies section reports low-strength evidence that bupropion improved cocaine abstinence. The Other Pharmacotherapies section reports improved abstinence with antidepressants as a class among patients with comorbid OUD. Neither passage establishes that patients with OUD are more likely than other patients to benefit specifically from bupropion; the Discussion instead identifies comorbid depression and contingency management as possible contexts for bupropion benefit. Page numbers are unavailable in our copy. (LLM, conf=0.84)

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Authors
Chan, B., Kondo, K., Freeman, M., Ayers, C., Montgomery, J., & Kansagara, D.
Affiliations
  • Oregon Health & Science University (US)
  • Portland VA Medical Center (US)
Corresponding author
Chan, Brian
ORCID
Venue
Journal of General Internal Medicine
Publisher
Springer Science and Business Media LLC
Published
2019-06-10
Volume
34
Issue
12
Pages
2858-2873
ISSN
  • 0884-8734 (ISSN-L)
  • 1525-1497
DOI
10.1007/s11606-019-05074-8
PMC
PMC6854210
OpenAlex
W2952695707
Cited by
150
References
85
Citations by year
2026: 16 · 2025: 27 · 2024: 32 · 2023: 21 · 2022: 27 · 2021: 17 · 2020: 9 · 2019: 1
FWCI
1.97
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of General Internal Medicine (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Quality Enhancement Research Initiative (NA)
  • AHRQ PCOR K12 (K12HS022981)
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
  • Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
Keywords
cocaine dependence, pharmacotherapy, cocaine abstinence, relapse prevention, bupropion, topiramate, psychostimulants, antipsychotic drugs, antidepressants, treatment retention, contingency management, addiction treatment
MeSH terms
Antidepressive Agents, Central Nervous System Agents, Cocaine, Drug Therapy, Humans, Antipsychotic Agents, Cocaine-Related Disorders

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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