Modafinil may be a possible medicinal treatment for cocaine dependence

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Cocaine dependence is a major public health problem affecting thousands of people around the globe. Despite years of active research there are still no approved medications for the treatment of this life-shattering addiction. Researchers are now hopeful that may soon change based on the results of a controlled study done at the University of Pennsylvania School of Medicine.

The study's findings can be found in the January issue of Journal of Neuropsychopharmacology and on-line at www.neuropsychopharmacology.org. Penn investigators have identified Modafinil – a wake-promoting agent approved for the treatment of narcolepsy – as a possible medicinal treatment for cocaine dependence. In a double-blind, placebo-controlled trial, researchers found Modafinil promoted cocaine abstinence in treatment-seeking outpatients. Modafinil was also shown to blunt cocaine-induced euphoria in a prior study conducted by the same research group, perhaps explaining its clinical advantage. "If confirmed by further investigation, this could be the breakthrough we have been waiting for," says Charles Dackis, MD, Chief of Psychiatry at the University of Pennsylvania Medical Center – Presbyterian, and the study's principal investigator.

"Cocaine is capable of destroying not only the lives of those addicted, but also those around them," adds Dackis. "An effective treatment for cocaine addiction would help those most vulnerable in our society to overpower their addiction and regain control in their lives." The trial was conducted at Penn's Treatment Research Center between 2002 and 2003. It involved a sample of 62 cocaine-dependent patients (aged 25-63) free of significant medical and psychiatric conditions. All participants were from the Philadelphia area. After initial screenings, eligible patients were randomized to a single morning dose of Modafinil (400 mg), or matching placebo tablets, that was continued for eight weeks along with twice-weekly cognitive behavioral therapy (CBT). Thirty participants were treated with Modafinil; and 32 were given placebo.

The primary efficacy measure was cocaine abstinence, measured by urine toxicity testing. Secondary measures were craving, cocaine withdrawal, retention, and adverse events. Modafinil-treated patients provided significantly more cocaine-negative urine samples over the eight-week period than those given placebo, and were more likely to achieve protracted cocaine abstinence.

Along with this finding, Penn researchers also discovered that there were no serious adverse events in those treated with Modafinil, and none of the patients failed to complete the study as a result of any side effects. "These preliminary results are very promising and three larger studies of modafinil for cocaine dependence are currently underway, including one at Penn," adds Dr. Dackis.

This study was funded by research grants from the National Institute of Drug Abuse. Cephalon Inc. provided Modafinil and matched placebo tablets, but had no participation in the design or implementation of the trial. Other Penn researchers contributing to the study are Kyle M. Kampman, MD, Kevin G. Lynch, PhD, Helen M. Pettinati, PhD, and Charles O'Brien, MD, PhD.

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