Treatment: Antabuse + Revia
In short, they make you sick if you attempt to get high, and they decrease cravings.
It was reported at a meeting of the American Society of Addiction Medicine (ASAM), in a panel presentation about naltrexone, that Yale University researchers reported that disulfiram (Antabuse) reduced cocaine use independent of alcohol use. It was suggested that a combination of disulfiram (Antabuse) and naltrexone (Revia) might be useful in the treatment of cocaine abuse. The Yale data was confirmed by researchers at the University of Pennsylvania.
Later studies reported that the combination of buprenorphine and disulfiram (Antabuse) reduced cocaine abuse. This was published by the National Institute of Drug Abuse (NIDA).
We began prescribing disulfiram (Antabuse) to our opiate dependant patients after detoxification and naltrexone pellet placement when they reported using cocaine. Patients reported dysphoria and/or nausea when they used cocaine.
Patients presenting with a cocaine problem to whom we have prescribed disulfiram (Antabuse) and naltrexone (Revia) have reported dysphoria and/or nausea with cocaine use. They report that their cocaine use decreased. A decrease in craving for cocaine when continued on the combination of the medications has been reported.
Of course, this use of Antabuse (disulfiram) and naltrexone constitute off label uses of the medications. However, there is some support for their use this way in the literature as well as anecdotal reports.
Cocaine HCl is used primarily by insufflation (snorting) and by injection. Methamphetamine is used by insufflation (snorting) and by injection also. Both are also smoked in their base form as Crack (cocaine) and Ice (methamphetamine). Additionally the mechanism of action of cocaine and amphetamines is similar as well as the sensations they produce. Therefore, this medication combination, found useful in the treatment of patients with a cocaine problem, may also be useful in the treatment patients with a methamphetamine problem.
There seems to be a biological basis and there is currently no other medical treatment for cocaine abuse or methamphetamine abuse. Both medications have a wide therapeutic index when used as prescribed. A trial of this medical combination in these scenarios, cocaine or methamphetamine abuse, seems justified based upon the literature, the relative safety of the mnedications, our understanding of the similar biology of of these drugs of abuse, and anecdotal reports.