Disulfiram treatment for cocaine dependence in methadone-maintained opioid addicts.

Evaluated the efficacy of disulfiram for cocaine dependence, both with and without co-morbid alcohol abuse, in a group of methadone-maintained opioid addicts. This was a randomized, double-blind, placebo-controlled trial with 67 cocaine-dependent, methadone-maintained, opioid-dependent Ss. Study medication, either disulfiram or placebo, was placed directly in the methadone to ensure compliance for 12 wks. Primary outcome measures included weekly assessments of the frequency and quantity of drug and alcohol use, weekly urine toxicology screens and breathalyzer readings. Disulfiram treated Ss decreased the quantity and frequency of cocaine use significantly more than those treated with placebo. Alcohol use was minimal for all Ss regardless of the medication. It was concluded that disulfiram may be an effective pharmacotherapy for cocaine abuse among methadone-maintained opioid addicts, even in those individuals without co-morbid alcohol abuse. Disulfiram inhibits dopamine β-hydroxylase resulting in an excess of dopamine and decreased synthesis of norepinephrine. Since cocaine is a potent catecholamine re-uptake inhibitor, disulfiram may blunt cocaine craving or alter the "high", resulting in a decreased desire to use cocaine. (PsycInfo Database Record (c) 2021 APA, all rights reserved)