REPLACEMENT MEDICATION FOR COCAINE DEPENDENCE - METHYLPHENIDATE

Agonists, or ''replacement medications,'' are useful adjuncts in treat ment of opiate and nicotine dependence. They have not been systematica lly examined in cocaine dependence. Results of early open trials with methylphenidate for treatment of cocaine dependence were equivocal. Tw enty-four cocaine-dependent subjects were enrolled in an Ii-week doubl e-blind, placebo-controlled study of methylphenidate. Assignment was r andom. Intake included a 2-day human laboratory procedure in which sub jects received initial doses of methylphenidate or placebo. Subjects a ttended the clinic Monday through Friday and received oral doses of me thylphenidate (5 mg plus 20-mg sustained release) or placebo at 8:00 a .m., with afternoon and weekend take-home doses (20 mg sustained-relea se or placebo) provided in Medication Events Monitoring System bottles to monitor compliance. Clinic visits included therapy sessions, elect rocardiograms, self-report measures, and twice-weekly urine screens. T he two groups were equivalent in terms of retention (methylphenidate 4 8% and placebo 42%) and had similar cocaine use outcomes (40% benzoyle cgonine-positive urine screens). There were no significant adverse eff ects. The doses were sufficient to permit detection of psychoactive ef fects (''stimulant,'' ''more energy'') and side effects (''jitteriness ,'' ''eating less'') without increased ''craving.'' Additional medicat ions with different effects profiles are being studied to further eval uate the replacement model in cocaine dependence.