Summary of evidence

Antidepressants
Dopamine agonists
Dopamine antagonists
Disulfiram
CNS stimulants
Vaccines
Calcium blockers
Opioid agonists and antagonists
Alternative therapies

Antidepressants

Key points:

• Transition to injecting can be prevented with CBT intervention.
  Strength of evidence: 1 star
  
  
• There is no current evidence supporting the clinical use of antidepressants in the treatment of cocaine dependence.
  Strength of evidence: 3 stars
  
  
• Antidepressants have very limited benefits in the treatment of amphetamine dependence.
  Strength of evidence: 3 stars
  
  
• Antidepressants may be suitable in cases of concomitant cocaine dependence and depression.
  Strength of evidence: ?
  
  

Dopamine agonists

Key points:

• There is no current evidence supporting the clinical use of dopamine agonists in the treatment of cocaine dependence.
  Strength of evidence: 3 stars
  
  

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Dopamine antagonists

Key points:

• There is no current evidence supporting clinical use of carbamazepine in the treatment of cocaine dependence.
  Strength of evidence: 3 stars
  
  
• Phenytoin may be more effective than placebo in reducing cocaine use.
  Strength of evidence: 2 stars
  
  
• Flupenthixol, haloperidol and risperidone are probably not useful due to side-effects.
  Strength of evidence: 3 stars
  
  

Disulfiram

Key points:

• Disulfiram as an adjunct to buprenorphine or methadone maintenance may reduce cocaine use in opioid-dependent people.
  Strength of evidence: 3 stars
  
  

CNS stimulants

Key points:

• Prescription of oral amphetamines is of potential value as a substitution treatment for dependent, injecting amphetamine users.
  Strength of evidence: 2 stars
  
  
• Methylphenidate is not generally effective in reducing cocaine use.
  Strength of evidence: 3 stars
  
  
• Dexamphetamine may be of value in reducing cocaine use.
  Strength of evidence: 2 stars
  
  

Vaccines

Key points:

• Cocaine vaccines may provide therapeutic support by reducing the psychoactive effect of cocaine.
  Strength of evidence: ?
  
  

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Calcium blockers

Key points:

• Calcium blockers may, or may not, have therapeutic effect.
  Strength of evidence: ?
  
  

Opioid agonists and antagonists

Key points:

• Combined behavioural and pharmacological treatment for cocaine users who are also opioid dependent may reduce cocaine use.
  Strength of evidence: 2 stars
  
  
• Buprenorphine is no more effective than methadone in reducing cocaine use amongst opioid dependent clients.
  Strength of evidence: 3 stars
  
  

Alternative therapies

Key points:

• Auricular acupuncture does not appear to significantly reduce cocaine use.
  Strength of evidence: 2 stars