Bupropion may promote cocaine abstinence in some opioid users

Key takeaways:

• For some people being treated for opioid addiction, bupropion, in addition to monetary compensation, may encourage cocaine abstinence.
• The findings indicate tailored cocaine use treatments may be beneficial.

In addition to a financial incentive, bupropion may help some people being treated for opioid use disorder to stop using cocaine, according to findings published in JAMA Network Open.

“Cocaine use is something our patients receiving methadone report wanting help with, and until now, very few treatments have been successful at helping them stop using cocaine,” Kelly Dunn, PhD, MBA, a professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, said in a press release. “Providing a monetary incentive is one of the most effective treatment strategies for cocaine use disorder.”

Dunn and colleagues enrolled 80 adults who self-reported cocaine use in the past 30 days who attended one of four methadone clinic programs in Baltimore for opioid use disorder (OUD) from March 2015 to September 2019.

All participants received a financial incentive for attending thrice-weekly visits over the 30-week trial period and for each urine test that was negative for cocaine use. Additionally, the researchers randomly assigned participants 1:1 to bupropion slow release (150 mg twice per day) or placebo.

In the first 6 weeks of the trial, 20 people were abstinent for 2 consecutive weeks and were assigned to receive incentives to prevent relapse. The rest of the cohort was assigned to receive incentives to become abstinent.

Initial analyses revealed no difference in self-reported or urine test-confirmed cocaine use between the bupropion group and the placebo group.

Subgroup analyses by incentive type showed that, among the abstinence incentive group, participants using bupropion slow release were more likely to have become abstinent by the end of the study compared with participants who received placebo (66.7% vs. 30%; P = .04). However, there were no differences in cocaine use cessation between the bupropion and placebo groups within the relapse prevention group.

“Pairing bupropion to prevent cocaine use after the monetary incentives are discontinued may be a promising treatment strategy,” Dunn said in the release. “Our study showed that bupropion can work for a subgroup of people with OUD, and that whether or not they respond initially to treatment is a meaningful determinant as to the intensity of treatment they might need going forward.”

References:

• Antidepressant medication may be key to help people stop use of cocaine while in treatment for opioid use disorder. https://www.hopkinsmedicine.org/news/newsroom/news-releases/antidepressant-medication-may-be-key-to-help-people-stop-use-of-cocaine-while-in-treatment-for-opioid-use-disorder. Published March 15, 2023. Accessed March 22, 2023.
• Ware OD, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2023.2278.