Emerging drugs for the treatment of cocaine use disorder: a review of neurobiological targets and pharmacotherapy

Abstract

Introduction: Cocaine use is a global public health concern of significant magnitude, negatively impacting both the individual as well as larger society. Despite numerous trials, the discovery of an effective medication for treatment of cocaine use disorder remains elusive.

Areas covered: This article reviews the emerging pharmacotherapies for treatment of cocaine use disorder, focusing on those medications that are currently in Phase II or III human clinical trials. Articles reviewed were obtained through searches of PubMed, Ovid MEDLINE, Clinicaltrials.gov and the Pharmaprojects database.

Expert opinion: Research into cocaine pharmacotherapy must continue to show innovation. Given that medications targeting single neurotransmitter systems have demonstrated little efficacy in treatment of cocaine use disorder, the recent focus on pharmacotherapeutic agents with multiple neurobiochemical targets represents an exciting shift in trial design and approach. Additionally, consideration of pharmacogenetics may be helpful in identification of subpopulations of cocaine-dependent individuals who may preferentially respond to medications.

Keywords:

• clinical trial
• cocaine
• pharmacogenetics
• Phase II
• Phase III

Declaration of interest

D Shorter received support from VA CSR&D I01BX007080. CB Domingo and TR Kosten were supported by NIH/NIDA 5 P50 DA018197-05. This material is the result of work supported with resources and the use of facilities at the Michael E DeBakey VA Medical Center. The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.