Peter Roy-Byrne, MD reviewing Nuijten M et al. Lancet 2016 Mar 22. Dürsteler KM and Vogel M. Lancet 2016 Mar 22.

Oral dextroamphetamine was modestly effective for reducing cocaine use in heroin-dependent patients who were receiving daily, in-person heroin-assisted treatment.

Ongoing cocaine dependence can compromise heroin-assisted treatment for patients with methadone-refractory heroin dependence. In a multicenter trial from the Netherlands, researchers randomly assigned 73 cocaine-dependent patients who were getting daily heroin- and methadone-assisted treatment to receive sustained-release oral dextroamphetamine (dexamphetamine; 60 mg/day) or placebo for 12 weeks. Twice-weekly urine samples were collected during the final 4 weeks. Sixty-five participants (89%) completed the study.

Dextroamphetamine recipients had fewer days of self-reported cocaine use (mean, 45 vs. 61), a higher longest period of consecutive cocaine abstinence (mean, 18 vs. 7 days), and a higher proportion of cocaine-negative urine samples (11% vs. 4%) — all three differences with the placebo group were significant. Although agreement between self-reported use and urine toxicology was high (kappa value, 0.64), almost half the patients with no self-reported cocaine use had cocaine-positive urine samples. Cocaine craving did not differ between the two groups. Among dextroamphetamine recipients, 74% reported adverse events (mostly insomnia, agitation, and arousal).

Citation(s):

Nuijten M et al. Sustained-release dexamfetamine in the treatment of chronic cocaine-dependent patients on heroin-assisted treatment: A randomised, double-blind, placebo-controlled trial. Lancet 2016 Mar 22; [e-pub].

Dürsteler KM and Vogel M.Effective drug therapy for cocaine dependence: A milestone. Lancet 2016 Mar 22; [e-pub]. 

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