Co-occurring cocaine dependence is a frequent problem for opioid-dependent patients entering methadone-maintenance therapy (MMT). Some small studies have demonstrated decreased cocaine use among cocaine users treated with disulfiram, normally a treatment for alcohol dependence. To determine whether disulfiram reduces cocaine use in patients with both opioid and cocaine dependence initiating MMT, researchers conducted a placebo-controlled randomized trial in which 152 patients received either 0 mg, 62.5 mg, 125 mg, or 250 mg disulfiram daily (combined with their daily methadone dose) for 12 weeks following a 2-week MMT induction period.
- Sixty-five percent of subjects completed the study protocol. Retention did not differ between the 4 groups.
- The mean number of alcoholic drinks per week at baseline was less than 1 in all groups, which did not change significantly during the study in any group.
- The percentage of cocaine-positive urine tests increased in the 62.5 mg and 125 mg groups over 12 weeks but decreased (at similar rates) in the placebo and 250 mg groups.
- Self-reported cocaine use also increased over the study period in the 125 mg group. There were no significant changes in self-reported use in the other 3 groups.
- Six subjects receiving disulfiram discontinued use due to adverse events including rash and elevated liver enzymes.
In this trial, disulfiram did not reduce cocaine use in MMT patients with co-occurring cocaine and opioid dependence. In fact, patients taking low doses of disulfiram increased their cocaine use over the study period. These findings do not support disulfiram treatment for cocaine dependence in MMT patients. Additional trials are required to determine which cocaine-using populations may benefit from disulfiram treatment.
Alexander Y. Walley, MD, MSc
Oliveto A., Poling J, Mancino MJ, et al. Randomized, double blind, placebo-controlled trial of disulfiram for the treatment of cocaine dependence in methadone-stabilized patients. Drug Alcohol Depend. September 7, 2010 [E-pub ahead of print].