No Reduction in Cocaine Use with Disulfiram in Opioid- and Cocaine-Dependent Patients
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.