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Six-month trial of bupropion with contingency management for cocaine dependence in a methadone-maintained population.
Arch Gen Psychiatry. 2006 Feb; 63(2):219-28.AG

Abstract

CONTEXT

No effective pharmacotherapies exist for cocaine dependence, although contingency management (CM) has demonstrated efficacy.

OBJECTIVE

To compare the efficacy of bupropion hydrochloride and CM for reducing cocaine use in methadone hydrochloride-maintained individuals.

DESIGN

This 25-week, placebo-controlled, double-blind trial randomly assigned participants to 1 of 4 treatment conditions: CM and placebo (CMP), CM and 300 mg/d of bupropion hydrochloride (CMB), voucher control and placebo (VCP), or voucher control and bupropion (VCB).

SETTING

Outpatient clinic at the Veterans Affairs Connecticut Healthcare System.

PARTICIPANTS

A total of 106 opiate-dependent, cocaine-abusing individuals.

INTERVENTIONS

All study participants received methadone hydrochloride (range, 60-120 mg). Participants receiving bupropion hydrochloride were given 300 mg/d beginning at week 3. In the CM conditions, each urine sample negative for both opioids and cocaine resulted in a monetary-based voucher that increased for consecutively drug-free urine samples during weeks 1 to 13. Completion of abstinence-related activities also resulted in a voucher. During weeks 14 to 25, only completion of activities was reinforced in the CM group, regardless of sample results. The voucher control groups received vouchers for submitting urine samples, regardless of results, throughout the study.

MAIN OUTCOME MEASURE

Thrice-weekly urine toxicologic test results for cocaine and heroin.

RESULTS

Groups did not differ in baseline characteristics or retention rates. Opiate use decreased significantly, with all treatment groups attaining equivalent amounts of opiate use at the end of the study. In the CMB group, the proportion of cocaine-positive samples significantly decreased during weeks 3 to 13 (P<.001) relative to week 3 and remained low during weeks 14 to 25. In the CMP group, cocaine use significantly increased during weeks 3 to 13 (P<.001) relative to week 3, but then cocaine use significantly decreased relative to the initial slope during weeks 14 to 25 (P<.001). In contrast, by treatment end, the VCB and VCP groups showed no significant improvement in cocaine use.

CONCLUSION

These findings suggest that combining CM with bupropion for the treatment of cocaine addiction may significantly improve outcomes relative to bupropion alone.

Authors+Show Affiliations

Yale University School of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven 06516, USA. james.poling@yale.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

16461866

Citation

Poling, James, et al. "Six-month Trial of Bupropion With Contingency Management for Cocaine Dependence in a Methadone-maintained Population." Archives of General Psychiatry, vol. 63, no. 2, 2006, pp. 219-28.
Poling J, Oliveto A, Petry N, et al. Six-month trial of bupropion with contingency management for cocaine dependence in a methadone-maintained population. Arch Gen Psychiatry. 2006;63(2):219-28.
Poling, J., Oliveto, A., Petry, N., Sofuoglu, M., Gonsai, K., Gonzalez, G., Martell, B., & Kosten, T. R. (2006). Six-month trial of bupropion with contingency management for cocaine dependence in a methadone-maintained population. Archives of General Psychiatry, 63(2), 219-28.
Poling J, et al. Six-month Trial of Bupropion With Contingency Management for Cocaine Dependence in a Methadone-maintained Population. Arch Gen Psychiatry. 2006;63(2):219-28. PubMed PMID: 16461866.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Six-month trial of bupropion with contingency management for cocaine dependence in a methadone-maintained population. AU - Poling,James, AU - Oliveto,Alison, AU - Petry,Nancy, AU - Sofuoglu,Mehmet, AU - Gonsai,Kishorchandra, AU - Gonzalez,Gerardo, AU - Martell,Bridget, AU - Kosten,Thomas R, PY - 2006/2/8/pubmed PY - 2006/2/17/medline PY - 2006/2/8/entrez SP - 219 EP - 28 JF - Archives of general psychiatry JO - Arch Gen Psychiatry VL - 63 IS - 2 N2 - CONTEXT: No effective pharmacotherapies exist for cocaine dependence, although contingency management (CM) has demonstrated efficacy. OBJECTIVE: To compare the efficacy of bupropion hydrochloride and CM for reducing cocaine use in methadone hydrochloride-maintained individuals. DESIGN: This 25-week, placebo-controlled, double-blind trial randomly assigned participants to 1 of 4 treatment conditions: CM and placebo (CMP), CM and 300 mg/d of bupropion hydrochloride (CMB), voucher control and placebo (VCP), or voucher control and bupropion (VCB). SETTING: Outpatient clinic at the Veterans Affairs Connecticut Healthcare System. PARTICIPANTS: A total of 106 opiate-dependent, cocaine-abusing individuals. INTERVENTIONS: All study participants received methadone hydrochloride (range, 60-120 mg). Participants receiving bupropion hydrochloride were given 300 mg/d beginning at week 3. In the CM conditions, each urine sample negative for both opioids and cocaine resulted in a monetary-based voucher that increased for consecutively drug-free urine samples during weeks 1 to 13. Completion of abstinence-related activities also resulted in a voucher. During weeks 14 to 25, only completion of activities was reinforced in the CM group, regardless of sample results. The voucher control groups received vouchers for submitting urine samples, regardless of results, throughout the study. MAIN OUTCOME MEASURE: Thrice-weekly urine toxicologic test results for cocaine and heroin. RESULTS: Groups did not differ in baseline characteristics or retention rates. Opiate use decreased significantly, with all treatment groups attaining equivalent amounts of opiate use at the end of the study. In the CMB group, the proportion of cocaine-positive samples significantly decreased during weeks 3 to 13 (P<.001) relative to week 3 and remained low during weeks 14 to 25. In the CMP group, cocaine use significantly increased during weeks 3 to 13 (P<.001) relative to week 3, but then cocaine use significantly decreased relative to the initial slope during weeks 14 to 25 (P<.001). In contrast, by treatment end, the VCB and VCP groups showed no significant improvement in cocaine use. CONCLUSION: These findings suggest that combining CM with bupropion for the treatment of cocaine addiction may significantly improve outcomes relative to bupropion alone. SN - 0003-990X UR - https://www.unboundmedicine.com/medline/citation/16461866/Six_month_trial_of_bupropion_with_contingency_management_for_cocaine_dependence_in_a_methadone_maintained_population_ L2 - https://jamanetwork.com/journals/jamapsychiatry/fullarticle/10.1001/archpsyc.63.2.219 DB - PRIME DP - Unbound Medicine ER -