A drug to treat cocaine addiction?

~ Jason Schwartz
Structure of cocaine
Structure of cocaine (Photo credit: Wikipedia)

A recent study on the use of topiramate for cocaine addiction has been getting a lot of attention. Most of the coverage draws only from the researchers press release.

“Using an intent-to-treat analysis, the researchers found that topiramate was more efficacious than placebo at increasing the participants’ weekly proportion of cocaine nonuse days and in increasing the likelihood that participants would have cocaine-free weeks,” the university said Friday in a statement.

Similarly, Johnson’s team found a significant association between topiramate and both a decrease in craving for the drug and an improvement in the subjects’ overall level of functioning in comparison to a placebo.

Here are a few things you should know.

  1. What does “more efficacious than placebo” mean? It means that the number of days subjects did not use cocaine increased to 13.3% or 8.9%. (Depending on how you calculate it.) So, subjects still used cocaine 86.7% or 91.1% of days.
  2.  There a history of concerns about the manufacturer of the drug promoting off-label use of the drug.
  3. The lead researcher left his last post after losing a whistleblower lawsuit. One of his projects had been accused improperly charging the federal government for time spent on a study. He also attacked the character of the whistleblower.
  4. The lead researcher has a financial interest in topiramate.

I’m sure we’ll come up with effective drugs some day, but I’m skeptical that this is one of them.

Published by Jason Schwartz

I have been an addiction professional and social worker since 1994. I started blogging in 2005 as the Clinical Director at Dawn Farm. I no longer work at Dawn Farm and am now the Director of Behavioral Medicine at a community hospital, and a lecturer at Eastern Michigan University’s School of Social Work. Views expressed here are my own. Keep in mind that the field, the contexts in which the field operates, and my views have changed over time.

4 thoughts on “A drug to treat cocaine addiction?”

  1. Replacement therapy does not work. Even where some efficacy can be demonstrated, it can also be construed as merely “enhancing” the primary adddiction. Behaviours, attitudes, do not alter in the patient, generally.

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  2. Well, well, well. The devil is in the detail. Quite incredible how much of a spin can be put on a drug that seems to have such a small effect. Compare with your recent blog on the Litt paper on reduction in relapse by 27% simply with a behavioural intervention.

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    1. Emphasizes again the great caution needed when interpreting any of the claims made by the pharmaceutical companies about the benefits of a drug new or old, on or off label.

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  3. I’ve never been a fan of treating drug addiction with more drugs. And this topiramate is even associated with other major health concerns- apart from the four alarming points mentioned by you, Jason.

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