Heroin-dependent patients who are also struggling with cocaine dependence can be successfully treated for this second addiction using sustained-release dexamfetamine. That is written by Dutch investigators in The Lancet. In an accompanying comment, Swiss psychiatrists call these results a milestone.
Many people who are being treated for heroin dependence, are also dependent on crack, the freebase form of cocaine that can be smoked. Former studies have shown that sustained-release dexamfetamine could be a promising candidate to treat this second addiction. Mascha Nuijten and colleagues studied the efficacy, safety and acceptance in a multicentre, randomised, double-blind, placebo-controlled study.
They included 73 cocaine-dependent patients who had tried to quit at least twice without success and were being treated for their heroin dependence in a specialised centre. Of all patients, 63 finished the complete twelve-week program. Patients in the intervention group, were given (besides their regular treatment for their heroin dependence) 60 mg supervised prescription dexamfetamine on a daily basis. They performed better than the placebo group: they self-reported fewer days of cocaine use (mean of 44,9 versus 60,6 days) and longer stretches of cocaine-free periods (mean of 17,9 versus 6,7 days). They also used less cocaine and more often had a negative urine test in the last four weeks of the study. Adverse events occurred in both groups, but were well tolerated and of transient nature.
Kenneth Dürsteler and Marc Vogel, both working at the Psychiatric University Clinics Basel in Zwitserland, praise the study in a comment in the same issue of The Lancet. They are laudative about the size of the patient group, the used dose of dexamfetamine and the low number of patients that were lost to follow up. Dürsteler and Vogel think that the results are promising and suspect they will have clinical implications. The psychiatrists do however, like the researchers themselves, stress the fact that more research is needed with other patient groups and in other treatment settings.
Source: The Lancet
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