Desipramine in opioid-dependent cocaine abusers maintained on buprenorphine vs methadone

Background: Cocaine abuse occurs in 40% to 60% of patients entering opioid maintenance treatment, and effective pharmacotherapies are needed for this combined dependence. Methods: This 13-week, randomized, double-blind, placebo-controlled trial e valuated the efficacy of desipramine hydrochloride (0 or 150 mg/d) plus bup renorphine hydrochloride (12 mg/d) or methadone hydrochloride (65 mg/d) in 180 opioid-dependent cocaine abusers (124 men, 56 women). Supervised urine samples were obtained thrice weekly, and self-reported cocaine and heroin u se was reported once weekly. Desipramine plasma levels were determined at w eeks 4 and 10. Results: In men, opioid abstinence was increased more rapidly over time whe n treated with methadone than with buprenorphine, whereas cocaine abstinenc e was increased more with buprenorphine than with methadone. In women, opio id abstinence was increased the least rap-idly when treated with buprenorph ine plus placebo, while cocaine abstinence was increased more rapidly over time when created with methadone than with buprenorphine. Regardless of sex or opioid medication, desipramine increased opioid and cocaine abstinence more rapidly over time than placebo. Self-reported opioid use confirmed the se findings. Desipramine plasma levels were higher in women than in men, pa rticularly those on buprenorphine maintenance, Higher desipramine plasma le vels were associated with greater opioid, but not cocaine, abstinence. Conclusions: Desipramine may be a useful adjunctive medication in facilitat ing opioid and cocaine abstinence in opioid-maintained patients. The effica cy of opioid medications to treat opioid or cocaine dependence may differ b y sex. These findings highlight the importance of including ses as a factor when examining treatment outcome in these types of trials.