New Treatments for Cocaine AddictionAnna Ciulla
Cocaine addiction is a serious public health problem in this country, having accounted for more than one in three (40 percent) of all drug abuse-related emergency room visits, in data from the 2011 Drug Abuse Warning Network. While the runaway heroin and opiate crisis commands more of today’s headlines, what many don’t know is that as late as the year 2014, cocaine—not heroin—was the most frequently reported illegal drug seen in hospital emergency rooms, according to statistics from the Foundation for a Drug-Free World.
Such statistics make treating cocaine addiction a national priority, and thanks to emerging science, new Medication-Assisted Treatments (MATs)—medications in combination with counseling and behavioral therapies that reduce cravings and relieve other symptoms of substance use disorders (SUDs)—are now on the horizon. So, too, are non-pharmacological innovations like Transcranial Magnetic Stimulation (TMS), a non-invasive procedure that stimulates nerve cells in the brain via magnetic fields. This article will educate readers on these treatments for cocaine addiction and how they promise to be more effective than ever before in helping those who suffer.
Medication-Assisted Treatment for Cocaine: EMB-001
There are currently no medications approved by the Food and Drug Administration for treating cocaine use disorder—presumably because no proposed MAT thus far has shown the same levels of safety and effectiveness in reducing cravings and other symptoms that Suboxone has for heroin and opiate addiction. That may be changing in the near future, however. In July 2016, a patented combination of two FDA-approved drugs—the cortisol synthesis inhibitor metyrapone and the benzodiazepine oxazepam—entered its second phase of clinical development. EMB-001, as it is called, has already been tested on nicotine-, methamphetamine- and cocaine-dependent individuals with promising results. In a 2012 pilot study, EMB-001 treatment “significantly reduced cocaine use compared to placebo, produced significant reductions in cocaine craving, and was well tolerated over the 6-week treatment period,” according to a report earlier this year.
What makes EMB-001 a novel intervention for treating cocaine and other SUDs is how it works: whereas existing SUD medications (like Suboxone, for example) tend to work by blocking the euphoric effects of an addictive substance, EMB-001 supposedly targets the brain’s stress response circuits in an effort to suppress the cravings that are driving the drug-seeking behavior in the first place.
An article in Bioworld Today described the mechanisms of EMB-001’s therapeutic action this way: “In essence, EMB-001 takes the foot off the ‘accelerator’—the corticotropin-releasing factor (CRF)—while boosting the ‘brake’ of the gamma-aminobutyric acid (GABA) system.” The same article reported that the eventual goal is to develop a drug regimen that, when paired with psychosocial interventions for cocaine use disorders, will help recovering addicts abstain from cocaine and avoid relapse.
Other MATs for Cocaine
Other prospective MATs in recent years have been associated with positive treatment outcomes, too. Disulfiram (Antabuse), a drug that has been around for a while as a treatment for alcoholism, beat out its placebo competitor in a study of patients receiving buprenorphine (Suboxone) treatment. In another set of clinical trials, a combination of two existing drugs, buprenorphine plus naltrexone, cut cocaine use in rats that were administered the drug combination. And, in a 2013 study, the medication topiramate was more effective than a placebo in increasing abstinence, decreasing cravings, and improving the global functioning of those who received it.
This research joins findings in 2015 by researchers at the University of Colorado-Boulder into a second mechanism of action by which cocaine triggers addiction in the brain, and which the researchers believe may become the target for developing yet more new treatments for cocaine use disorders.
Transcranial Magnetic Stimulation for Cocaine
In August 2016, the head of the science policy branch of the National Institute on Drug Abuse, Dr. Maureen Boyle told Beach House Center for Recovery about “very promising” preliminary research into the therapeutic benefits of TMS for cocaine use disorder. Researchers in Italy wanted to know whether brain stimulation via TMS could reduce cocaine consumption, on the basis of prior studies showing that compulsive cocaine seeking strongly decreases activity in the brain’s prelimbic frontal cortex, which responds well to TMS stimulation (which boosts activity in this same region). Strikingly, the cocaine-addicted patients who received TMS experienced “significantly lower” cravings for cocaine and “significantly higher” rates of abstinence.
In citing this example of the hope that non-pharmacological treatments like TMS for cocaine and other addictions offer, Dr. Boyle was quick to caution that the small number of research subjects in the Italy study warrants larger future studies to confirm these encouraging results. Still, the preliminary findings seem to support both the safety of TMS and its potential therapeutic role in cutting cocaine use, according to the authors of the study, in an article published in 2016 in the journal, European Psychopharmacology.
Behavioral Therapies for Cocaine
TMS and emerging MATs for cocaine use disorder are intended to be paired with evidence-based counseling and behavioral therapies, such as Cognitive Behavioral Therapy, which has demonstrated positive recovery outcomes. That is because cocaine addiction, like other SUDs, is the complex interplay of social, psychological and spiritual dimensions that require therapeutic attention and support. Nonetheless, TMS and emerging MATs are promising new weapons in a growing medical arsenal to fight addiction in comprehensive ways and on behalf of the nearly one million Americans seeking cocaine treatment each year.