Dr Silvia Minozzi and colleagues recently published their review titled " Disulfiram for the treatment of cocaine dependencency". You can read the Plain Language Summary below or access the full review on the Cochrane Library.
Key messages
• In people with cocaine dependence, disulfiram compared to placebo may increase the number of people who are abstinent at the end of treatment, but may have little or no effect on the frequency and amount of cocaine use and on the number of people who have achieved and maintained abstinence for at least three weeks at the end of treatment. We are unsure if disulfiram has any unwanted effects in people with cocaine dependence.
• In people with cocaine dependence, disulfiram compared to naltrexone may reduce the frequency of cocaine use but may have little or no effect on the amount of cocaine use.
• Of the 13 studies included in our review, 11 took place in the USA. Furthermore, most people included in the studies were men. Our results may not be applicable in other contexts because the effects of treatment could be strongly influenced by social environment, ethnicity, and sex.
What is cocaine dependence?
Cocaine is one of the most commonly used psychostimulants worldwide. Psychostimulants are medicines or illegal drugs that stimulate the nervous system and have mood‐enhancing properties. The latest estimates indicate that more than 0.4% of adults have used cocaine at least once in the past year.
Cocaine use is associated with medical, psychological, and social problems, including the spread of infectious diseases (e.g. AIDS, hepatitis, tuberculosis), crime, violence, and drug exposure during pregnancy. Cocaine use can increase the risk of HIV infection through high‐risk injecting and sexual behaviours.
Cocaine dependence is a severe mental disorder characterised by an intense desire to use cocaine and inability to control cocaine use, causing people to use larger amounts than they intended.
How is cocaine dependence treated?
Cocaine dependence is usually treated with psychosocial treatments. No effective pharmacological treatments are available. Studies have evaluated whether a medication called disulfiram could help people with cocaine dependence. Disulfiram is currently used to treat people with alcohol dependence. It works by causing unpleasant physical reactions if the person drinks alcohol.
What did we want to find out?
We wanted to find out whether disulfiram can help people with cocaine dependence reduce their cocaine use or stop using cocaine altogether. We also wanted to know whether treatment with disulfiram was acceptable and safe for people with cocaine dependence.
What did we do?
We searched thoroughly for randomised studies (where people were allocated at random to one of two or more treatment groups) comparing disulfiram with no medicines, placebo (dummy treatment), or other medicines.
We compared and summarised the results and rated our confidence in the evidence, based on factors such as methods and precision of the results of each study.
What did we find?
We found 13 studies, which enroled 1191 people with cocaine dependence. The average duration of treatment was about three months. Twelve studies compared disulfiram with placebo or no pharmacological treatment, and three studies compared disulfiram with naltrexone (a medicine used to treat people with alcohol dependence or opioid dependence).
Main results
Disulfiram compared with placebo may increase the number of people who are not using cocaine at the end of treatment, but may have little or no effect on the frequency of cocaine use (number of days or weeks of cocaine use at the end of treatment), the amount of cocaine use (weight of cocaine used or money spent on cocaine at the end of treatment), the number of people who achieve and maintain abstinence for at least three weeks, and the number of people who prematurely interrupt the treatment. We are unsure if disulfiram has any unwanted effects in people with cocaine addiction.
Disulfiram compared with naltrexone may decrease the frequency of cocaine use but may have little or no effect on the amount of cocaine use or on the number of people who prematurely interrupt treatment.
What are the limitations of the evidence?
We cannot be sure that the studies allocated people to groups appropriately, as most studies did not describe this process in detail.
There were important variations in the characteristics of the people included in the studies: some had additional substance use disorders, some were using other medicines, and some were receiving other psychosocial treatments.
In addition, most people included in the studies were men, and 11 of the 13 studies took place in the USA. Therefore, our results may not apply to women or people living in other countries.
How up to date is this evidence?
This review updates our previous review. The evidence is up to date to August 2022.