Pills for speedballing or cocaine dependence

Cocaine’s behavioural and pharmacological eff ects can be studied directly, especially in animals. Compared with research in other mental disorders such as depression, in which the underlying disease mechanism can only be assumed from conceptual models, neuroscientifi c advances in the study of addictions are, arguably, at the fore in psychiatric research. Yet, unlike those other mental disorders, there is no drug treatment—let alone a cure— for cocaine dependence. Some possibilities are, however, emerging for the treatment of cocaine dependence when it accompanies opioid dependence (ie, speedballing). Cocaine abuse in opioid-dependent individuals is common. 42% of opioid addicts entering methadone treatment also abuse cocaine, and at 1-year follow-up this pattern persists in 22% of individuals. 1 Opioid addicts abusing cocaine have increased propensity not only for continued illicit drug use but also for sequelae, such as higher risk for HIV infection, interpersonal discord, and criminality. Opioid addicts benefi t from treatment with either opioid agonists (eg, methadone or levacetylmethadol), partial agonists (eg, buprenorphine), or the combination of a partial agonist and antagonist (eg, buprenorphine and naloxone). Cocaine use by opioid-abusing cocaine addicts can also be suppressed by high-dose methadone or buprenorphine maintenance treatment. 2