Randomized, double blind, placebo-controlled trial of disulfiram for the treatment of cocaine dependence in methadone-stabilized patients.

Author(s): Oliveto A, Poling J, Mancino MJ, Feldman Z, Cubells JF, Pruzinsky R, Gonsai K, Cargile C, Sofuoglu M, Chopra MP, Gonzalez-Haddad G, Carroll KM, Kosten TR

Affiliation(s): University of Arkansas for Medical Sciences, Psychiatry Dept., Slot 843, 4301 W. Markham St., Little Rock, AR 72205, USA.

Publication date & source: 2010-09-07, Drug Alcohol Depend., [Epub ahead of print]

This study examined the dose-related efficacy of disulfiram for treating cocaine dependence in methadone-stabilized cocaine dependent participants. DESIGN: One hundred and sixty-one cocaine- and opioid-dependent volunteers were entered into a 14-week, double blind, randomized, placebo-controlled clinical trial at two sites. METHODS: Participants were stabilized on methadone during weeks 1-2 and received disulfiram at 0, 62.5, 125 or 250mg/day during weeks 3-14. All participants also received weekly cognitive behavioral therapy. Thrice-weekly urine samples and weekly self-reported drug use assessments were obtained. RESULTS: Baseline subject characteristics, retention and drug use did not differ across groups. Outcome analyses were performed on those who participated beyond week 2. Opioid-positive urine samples and self-reported opioid use did not differ by treatment group. The prevalence of alcohol use was low prior to and during the trial and did not differ by treatment group. Cocaine-positive urines increased over time in the 62.5 and 125mg disulfiram groups and decreased over time in the 250mg disulfiram and placebo groups (p<0.0001). Self-reported cocaine use increased in the 125mg disulfiram group relative to the other three treatment groups (p=0.04). CONCLUSIONS: Disulfiram may be contraindicated for cocaine dependence at doses <250mg/day. Whether disulfiram at higher doses is efficacious in reducing cocaine use in dually cocaine and opioid dependent individuals needs to be determined. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.