There is currently no effective pharmacotherapy for treating stimulant drug abuse and dependence. Since intense drug craving is a standard feature of stimulant dependence, a great deal of research effort has been channeled into identifying medications that may help to reduce craving and other biologically-based contributors to relapse.
Thus far, numerous medications have appeared promising in initial open trials, but have not demonstrated efficacy in controlled clinical studies. These medications include dopamine agonists (e.g. amantadine, bromocriptine, methylphenidate, pergolide), carbamazepine and antidepressants (e.g. desipramine, fluoxetine, bupropron). A meta-analysis of 45 clinical trials concluded that these agents had no consistently positive effect on addiction treatment outcome in stimulant users, regardless of the type or dose of medication used.
The idea of substituting cocaine or methamphetamine with another CNS stimulant that has similar effects but less abuse potential has gained recent attention. Similar to buprenorphine or methadone replacement therapy for opioid dependence, the goal of stimulant replacement therapy would be to reduce cravings and other post-stimulant symptoms and thereby promote abstinence. Findings from a systematic review of controlled clinical trials evaluating the efficacy of a number of CNS stimulants (including dextroamphetamine, methylphenidate, modafinil, and bupropion) do not, however, provide strong support for using these stimulants to treat cocaine addiction. Nonetheless, some studies do suggest that these substitute medications, especially dextroamphetamine and modafinil, may have some potential utility in treating cocaine and methamphetamine dependence but further research is clearly needed.
One pharmacological agent shown to be helpful in treating stimulant dependence is disulfiram or Antabuse. The efficacy of disulfiram can be attributed to its ability to deter alcohol consumption – a common relapse trigger for stimulant use. More recent pharmacological research has focused on developing anti-cocaine vaccines that may attenuate or block CNS absorption into the brain but to date this work remains entirely experimental. Recent studies have also been trying to identify agents that may influence mechanisms by which stimulants are absorbed, metabolized, and excreted by the body, and give rise to their characteristic reinforcing effects in the brain.
It appears that pharmacotherapy is unlikely to provide a “magic bullet” for stimulant drug abuse and dependence. Experience with medications used for treating other types of drug dependencies supports the general notion that pharmacologic agents are likely to be most effective when combined with appropriate psychosocial intervention and support.