Findings of a recently published systematic review and meta-analysis revealed that although some pharmacological agents may help improve abstinence and treatment retention in patients with cocaine use disorder, the majority of these drugs are ineffective for treating this condition.

To better understand the effectiveness of pharmacological agents used in the management of cocaine use disorder, study authors searched MEDLINE, PsycINFO, and the Cochrane Library for systematic reviews and randomized controlled trials (RCTs) evaluating various treatment options in adult patients.

“When possible, we combined the findings of trials with comparable interventions and outcome measures in random-effects meta-analyses,” the authors explained. Additionally, standardized criteria were utilized to evaluate the risk of bias of individual studies as well as the strength of evidence for each outcome.

Outcomes of the analysis included continuous abstinence (for ≥3 consecutive weeks), use of cocaine, harms, and study retention. Relapse prevention studies, which evaluated patients who were abstinent at baseline, were also examined for lapse (defined as first cocaine positive or missed urine drug screen [UDS]) as well as relapse (defined as 2 consecutive cocaine positives or missed UDS).

A total of 7 systematic reviews and 48 RCTs evaluating 66 medications or drug combinations were included in the analysis. The study authors reported that antidepressants, which were assessed in 38 RCTs, were found to be ineffective for reducing cocaine use or improving treatment retention.

Although the strength of evidence was low, abstinence was found to be increased in patients using bupropion (RR: 1.63; 95% CI: 1.02, 2.59; 2 RCTs), topiramate (RR: 2.56; 95% CI: 1.39, 4.73; 2 RCTs), and psychostimulants (RR: 1.36; 95% CI: 1.05, 1.77; 14 RCTs). Additionally, an improvement in treatment retention was noted in patients receiving antipsychotics (RR: 1.33; 95% CI: 1.03, 1.75; 8 RCTs; moderate strength of evidence).

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“We found no strong or consistent evidence that any drug class was effective in increasing abstinence, reducing use, or improving treatment retention for people with cocaine use disorder,” the study authors concluded. They added, “Contingency management and behavioral interventions along with pharmacotherapy should continue to be explored.

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