"Twelve-step programs" like Cocaine Anonymous (modeled on Alcoholics Anonymous and Narcotics Anonymous) have been widely used to help people addicted to cocaine. Cognitive Behavioral Therapy (CBT) and Motivational Therapy (MT) have proven to be more helpful than 12-step programs in treating cocaine dependency. However, both of these approaches have a fairly low success rate.
Ibogaine has been researched a treatment for cocaine dependency. It is used in clinics in Mexico, the Netherlands, and Canada, but it cannot be used legally in the United States.
Non-drug treatments like acupuncture and hypnosis have been studied. However, these studies have not clearly shown that acupuncture or hypnosis helps with cocaine withdrawal.
Cocaine addiction continues to be the second-most difficult addiction to manage, behind heroin addiction.
Medications that have been studied to treat cocaine withdrawal include acetylcysteine, baclofen, bupropion, vanoxerine, and vigabatrin.
Kim Janda has been working for years on a vaccination that would treat cocaine use disorders.
The anti-depressant desipramine, and the stimulants methylphenidate and pemoline, have been used to treat cocaine dependence in people who also have a mental illness.
Several drugs have been used to treat cocaine withdrawal and cravings:
Finally, drugs have been used to cause an "aversion reaction" (a very bad reaction) when given with cocaine. The most common of these drugs is phenelzine.
On February 14, 2011, two Swiss psychologists published two years' research on cocaine addiction. They found that addicts who gambled were less likely to use cocaine or to relapse on cocaine. They think gambling may refocus the brain's "reward center" from cocaine to gambling. They said that psychotherapy should be used along with gambling. More research is being done on long-term relapse rates (the number of people who eventually start using cocaine again).
However, a more recent study looked at prize-based contingency management: a treatment method that offers addicts chances to win prizes if they do not use cocaine. This study found that prize-based contingency management helped cocaine addicts stay off cocaine, whether or not they had gambled recently. This suggests that it is the chance of a reward, not the gambling itself, that helps cocaine addicts stay off of cocaine.
Naloxone
Naloxone (often called Narcan), is a medication. It is used to reverse the effects of opioid painkillers, especially when a person has overdosed on opioids. Examples of opioids include:
These painkillers are central nervous system depressants. This means they slow down certain areas of the brain. If a person takes too many opiates, this can shut down the part of the brain that controls breathing. The person may become unable to breathe and die.
When a person has taken too much of one of these painkillers, naloxone can reverse the painkillers' effects and save the person's life.
Naloxone may be mixed into the same pill as an opioid painkiller to decrease the risk of misuse.
When given intravenously (into a needle placed into a vein), naloxone works within two minutes. When injected into a muscle, it works within five minutes. The medication may also be shot up the nose.
The effects of naloxone last about half an hour to an hour. Since most opioids last longer than naloxone, a person may need several doses of naloxone to fight the effects of an overdose.
When a person takes opioids, the opioids have to attach to certain receptor sites in the brain in order to work, like a lock in a keyhole. Once the opioids attach to these opiate receptor sites - like a lock fitting into a keyhole - the opiates start to work. They kill pain, create euphoria, and make people feel calm and relaxed. But if a person takes too many opiates, they can also make it impossible to breathe.
Naloxone fits better onto these opiate receptor sites than actual opiates do. If a person takes naloxone, the naloxone will throw any opiate off of the opiate receptor sites (like a key getting taken out of a door). Naloxone will stay attached to these opiate receptor sites. This reverses the effects of the opiates that the person took.
Naloxone reverses the effects of opiates. Because of this, if a person who is addicted to opiates gets naloxone, they will have symptoms of opioid "withdrawal". People have withdrawal symptoms when their body gets used to having opiates all the time.
Because naloxone reverses the effects of opiates, the side effects of naloxone can include restlessness, agitation, nausea, vomiting, a fast heart rate, pain, and sweating. To prevent this, small doses every few minutes can be given until the desired effect is reached.
Naloxone has to be given carefully to people with heart disease. Naloxone can cause more heart problems, like changes in the rhythm of the heart beat, in these people.
Naloxone seems to be safe in pregnant women. Naloxone is a pure opioid antagonist.
In rare cases, naloxone causes seizures and pulmonary edema (fluid in the lungs).
Naloxone was patented in 1961 by Jack Fishman, Mozes J. Lewenstein, and the company Daiichi Sankyo. The drug was approved for opioid overdose by the Food and Drug Administration (FDA) in 1971. It is on the World Health Organization's Model List of Essential Medicines, the most important medications needed in a basic health system.
Naloxone is available as a generic medication and is not very expensive. Its wholesale price is between $0.50 and $5.30 USD per dose.
Naloxone can be used to reverse opioid overdose and to reduce the slowed breathing or mental depression that opioids can cause.
Naloxone is included as a part of emergency overdose response kits distributed to heroin and other opioid drug users. This has been shown to reduce deaths due to overdose.
A prescription for naloxone is recommended if a person is:
If naloxone is prescribed to a person, that person should also be taught about how to prevent, identify, and react to an overdose, including how to perform rescue breathing, CPR, and how to call an emergency telephone number like 9-1-1.
Naloxone may be mixed with a number of opioids like buprenorphine. (Buprenorphine mixed with naloxone is called Suboxone.) Buprenorphine is used to decrease cravings for opiates. When buprenorphine and naloxone are mixed, and taken by mouth, only buprenorphine has an effect. Buprenorphine is a long-acting partial opioid agonist, meaning that although it binds to the body’s opioid receptors, it produces milder effects over a more prolonged period of time vs. the commonly abused full opioid agonists (heroin fentanyl, oxycodone, etc.). Buprenorphine has a high affinity for the opioid receptor, thereby preventing illicit and prescription opioid painkillers from attaching to the receptor. This leads to a lower risk of overdose and generally doesn’t produce a high in people who use opioids. Naloxone is added to reduce the risk of misuse, as it blocks the effects of buprenorphine if the medication is injected. But if a person misuses Suboxone by injecting it or taking large doses, the naloxone blocks the effect of the opioid. This combination is used to try to prevent abuse.
Pulmonary edema
Pulmonary edema (pulmonary oedema in British English) is fluid in the lungs ("Pulmonary" means "lungs"; "edema" means "swelling" or "fluid"). Normally, the lungs fill with air when a person breathes in. From the alveoli in the lungs, oxygen goes into the blood. The blood then carries oxygen to the entire body. Every part of the body needs oxygen to survive.
When a person has fluid in their lungs (pulmonary edema), there is not enough space left for air to get into the lungs. The person will not be able to breathe in as much air. This means not as much oxygen will get into the blood, and the body will not get the oxygen it needs.