Pharmacotherapy for Cocaine Use Disorders

Cocaine is one of the most commonly used substances worldwide. It has a strong addictive potential, which often leads to excessive consumption causing pronounced physical and psychological harm to users. There is currently no approved or effective medication to treat cocaine use disorders. However, in the last decades, significant efforts have been made to identify medications that could increase the effectiveness of treatments, with several drugs showing some promise. Although current evidence to either support or reject their ultimate efficacy is insufficient, encouraging indications have been found in studies testing dopamine agonists to reduce cocaine use or prevent relapse. Particularly, positive signals have been identified for long-acting amphetamine formulations and for modafinil, each under specific conditions such as comorbid psychiatric disorders. Medications addressing cocaine-related glutamate disturbances, such as N-acetylcysteine and ketamine, have also shown some beneficial effects on cocaine craving and other withdrawal symptoms as well as on the severity of cocaine use. However, it remains unclear whether these drugs can consistently achieve therapeutic benefits in the longer term and in heterogeneous clinical populations. In sum, conclusive statements about the clinical efficacy of the tested medications cannot yet be made. While renewed emphasis on the discovery of novel drug targets for the treatment of cocaine use disorders is needed, there is also a clear necessity for further investigation of the most promising existing medications, such as ketamine, N-acetylcysteine, modafinil, and extended-release amphetamines, in longitudinal study designs with large patient samples to establish their potential long-term therapeutic value.