CATCH: New pharmacological treatment options for crack-cocaine dependence. Results from three randomised controlled trials

Abstract

Crack-cocaine dependence is a serious and complex problem with as yet no adequate treatment. The CATCH project was initiated to explore new pharmacological treatment options for crack-cocaine dependence in the Netherlands.

In three separate parallel-group, randomised controlled, feasibility trials, three promising medications were investigated for their acceptance, efficacy, and safety in the treatment of crack-cocaine dependence: (1) topiramate 200 mg/day, (2) modafinil 400 mg/day, and (3) sustained-release (SR) dexamfetamine 60 mg/day.

In our first trial, topiramate was safe and well-tolerated in the sample of crack-cocaine dependent patients, but efficacy was not supported, probably due to low acceptance of the treatment. Acceptance and benefits of modafinil were not demonstrated in our second trial, most likely due to low adherence. However, in a post hoc analysis, substantial cocaine use reductions were found in a high modafinil-adherent subgroup. Our third trial showed that SR dexamfetamine is a well-accepted, effective, and safe agonist treatment for comorbid treatment-refractory cocaine dependence in heroin dependent patients in heroin-assisted treatment. To conclude, our study is an important contribution to the addiction research field, with negative findings pertaining to the efficacy of topiramate, ambiguous findings for modafinil, and promising findings for agonist substitution treatment with SR dexamfetamine.