Recent Notable Developments in Addiction Pharmacotherapies
Several recent studies have potentially important implications for practice:
- In one small randomized trial, 60 methamphetamine-dependent men who have sex with men were assigned to mirtazepine or placebo, both added to counseling. Although medication adherence was modest, methamphetamine-positive urine tests were half as frequent among men in the mirtazepine group, who also reported fewer risky sexual behaviors than those in the placebo group.
- In another small randomized trial (N=37), people with cocaine dependence were assigned to varenicline or placebo. All participants received counseling. Those on varenicline were twice as likely to have negative urine tests for cocaine, and they also reported less reward from cocaine use.
- In a larger (N=137) randomized placebo-controlled trial, trazodone had no effect on sleep or drug use among methadone-maintained opioid-dependent patients with sleep complaints.
Comments:Despite being early reports and, therefore, inconclusive, the 2 studies among stimulant-dependent patients are important, because pharmacological interventions targeting this group have not been particularly successful. These results hold some promise if they can be replicated. Trazodone is often recommended for insomnia in patients with substance dependence because it has little addiction risk, but the study in methadone-maintained patients suggests that it may not work. Thus, the search for safe and efficacious alternatives should continue. Richard Saitz, MD, MPH
Colfax GN, Santos G-M, Das M, et al. Mirtazapine to reduce methamphetamine use: a randomized controlled trial. Arch Gen Psychiatry. 2011;68(11):1168– 1175.
Plebani JG, Lynch KG, Yu Q, et al. Results of an initial clinical trial of varenicline for the treatment of cocaine dependence. Drug Alcohol Depend. 2012;121(1):163–166.
Stein MD, Kurth ME, Sharkey KM, et al. Trazodone for sleep disturbance during methadone maintenance: a double- blind, placebo-controlled trial. Drug Alcohol Depend. 2012;120(1):65–73.