Cocaine Use Reduction with Buprenorphine

Cocaine is a highly-addictive stimulant drug that produces powerful feelings of euphoria. It comes in the form of a white powder that is smoked, snorted, and injected as a recreational drug. The DEA has classified cocaine as a Schedule II drug based on its high potential for abuse which can lead to severe psychological and physical dependence. Cocaine use can cause a variety of health issues, including seizures, stroke, heart rhythm abnormalities, and damage to multiple organ systems.

Currently, there are no medications approved for the treatment of cocaine addiction in the United States. However, researchers are studying several potential pharmacological candidates to help reduce cocaine use among recovering addicts. One of the medications being explored is called buprenorphine. A trial called cocaine use reduction with buprenorphine (CURB) has shown promising results.

Cocaine Addiction: Facts and Figures

According to the National Survey on Drug Use and Health (NSDUH) 2018, cocaine use has remained relatively stable in the United States over the past decade or so. However, it continues to be a serious problem with millions of Americans battling crack/cocaine addiction. Some of the statistics that demonstrate the scope of the problem are listed below:

  • An estimated 5.5 million Americans over the age of 12 report cocaine use within the past year. This number includes 757,000 crack users. In other words, 2% of the total population of the United States has used cocaine in the preceding year.
  • Among past-year abusers of cocaine, 112,000 were adolescents in the age group of 12 to 17 years.
  • Cocaine use is highest among young adults aged 18 to 25 years. Nearly 6% in this age group report past-year use of crack/cocaine.
  • Roughly 875,000 people used cocaine for the first time in 2018. This number translates to roughly 2,400 people initiating cocaine use every day in the United States.
  • Nearly 15% of American adults report lifetime cocaine use.
  • Roughly 40% of drug-associated emergency room visits involve cocaine.
  • Cocaine overdoses claim about 5,000 American lives each year.

How is Cocaine Addiction Treated?

Cocaine addiction, like all drug addictions, is a complex disease that involves structural changes in the brain as well as a wide range of social and environmental factors. Therefore, any effective treatment for cocaine use needs to address a broad context of factors and also treat co-occurring mental health issues.

At present, the U.S. Food and Drug Administration has not approved any pharmacologic therapies for cocaine use and dependence. Researchers are exploring several possible targets. Much of the research is focused on a chemical called dopamine. Dopamine is a neurotransmitter in the human brain that mediates pleasurable emotions and reward centers. Dopamine is of interest to researchers because cocaine produces its intense euphoric effects by flooding the brain with dopamine. Scientists are also studying other neurotransmitters (brain chemicals) such as serotonin, GABA, and norepinephrine as potential neurobiological targets.

In the search for effective medications to treat cocaine use, researchers are exploring the role of a drug called buprenorphine, either alone or combined with naltrexone.

What is Buprenorphine?

Buprenorphine is a drug that belongs to a class called opiate (narcotic) analgesics. It is used to treat severe pain in people who need round-the-clock relief from pain that is not responsive to other medications.

Buprenorphine or the combination of buprenorphine and naloxone is also used to treat opioid addiction. Opioid addiction is a dependence on opioid drugs, including prescription pain relievers and the illegal drug heroin. Buprenorphine, which itself is an opioid, helps prevent withdrawal symptoms in people coming off opioid drugs by producing similar effects to these drugs.

Its role in the treatment of opioid use disorders is well-established, but now researchers are exploring the potential effectiveness of buprenorphine in helping people with a crack/cocaine addiction.

The CURB Trial

The Clinical Trials Network of the National Institute on Drug Abuse conducted the CURB (cocaine use reduction with buprenorphine) trial. This study was designed to investigate the effectiveness and safety of buprenorphine (Suboxone) or buprenorphine plus naltrexone (Vivitrol) to treat cocaine addiction.

The double-blind, placebo-controlled study was conducted at 11 geographically-varied sites in the United States and enrolled 300 participants. The criteria for inclusion in the study were a diagnosis of cocaine dependence as per DSM-IV criteria along with present or past opioid abuse/addiction. Since buprenorphine is an opioid drug itself, the study only enrolled cocaine users with a simultaneous opioid use disorder to avoid exposing opioid-naïve patients to an opioid drug, i.e., buprenorphine.

Participants in the study were randomly assigned to one of three groups. The first group received 4 mg of buprenorphine, the second group received 16 mg of buprenorphine, and the third group received a placebo (inactive substance with no therapeutic value) for 8 weeks of treatment. An injection of naltrexone was given 4 weeks after the initial treatment. Naltrexone works differently than buprenorphine and reduces drug cravings.

Can Buprenorphine Reduce Cocaine Use?

Results of the CURB trial showed promise in treating cocaine use disorders with buprenorphine. Specifically, buprenorphine has beneficial effects in reducing cocaine use among opioid-dependent individuals. Besides the CURB trial, other studies have shown that 8 or 16 mg of buprenorphine daily is well tolerated and can effectively reduce concomitant use of opiates and cocaine. Also, buprenorphine given along with naltrexone is well tolerated and can help reduce cocaine use.

However, it is worth noting that studies indicate the entire population of cocaine-dependent patients cannot be treated with a single strategy. In other words, there is a need to identify effective medications that match the specific needs of individual patients.

Final Takeaway

The lack of effective medications for cocaine use and dependence underscores the need to promote further pharmacological research. This will hopefully translate into real-world treatments for cocaine dependence.

Findings of studies suggest that buprenorphine is beneficial in reducing cocaine use, but larger, randomized, blinded trials are needed in individuals with a primary cocaine dependence before buprenorphine can be offered as a standard treatment for cocaine use disorder.

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