By Seth Daniel
Though most treatment research focuses on the opiate epidemic these days, one doctor at Boston Medical Center (BMC) is looking at how to help people curtail their use of cocaine use with diet drugs already approved by the Food and Drug Administration (FDA).
Dr. Eric Devine and BMC’s Psychiatry Research Center told the Sun they have received funding from National Institute of Drug Abuse (NIDA) to study whether the diet drug lorcaserin also could help those struggling with cocaine addiction.
“The Center works on identifying medications that might help treat addiction,” he said. “We try to look for medications that are already FDA approved for other uses and might be helpful to also treat addiction. In this case, these are diet medications and they are readily available and already approved, which clears away a lot of hurdles.”
He said the research on such things is incredibly important because the pharmaceutical companies seem to have a limited interest in medications to help treat addiction, especially those that already exist and are approved for other uses – such as the diet drug.
“Big Pharma doesn’t spend a lot of time and money on developing treatments for substance-abuse disorder,” he said. “If it weren’t for places like us trying to redevelop FDA approved drugs for substance abuse treatment, I don’t know whether anyone would be looking seriously at doing this…Pharma isn’t coming up with much. It’s been since 2006 since any new medications have been approved for treating alcohol. I do wish big pharma would do more to help us.”
In the climate of an opiate epidemic, many aren’t thinking about cocaine use – which includes crack cocaine use. However, at the street level, many police departments are noting an increase in cocaine use and illicit cocaine sales.
Last summer, the federal Office of National Drug Control Policy reported that cocaine production in the South American Andean region was at an all-time high.
“Despite a decrease in the cultivation of coca in Peru for 2016, cocaine production in the Andean region as a whole is at record levels and challenging cocaine-supply reduction efforts,” read the report. “In March, ONDCP released data on Colombia’s cocaine cultivation and production, which showed record levels of both cultivation and potential production. This represents an 18 percent increase in cultivation and a 37 percent increase in potential production over 2015 levels. More than 90 percent of the cocaine samples seized in the continental United States originate in Colombia.”
The report indicated that cocaine use in America is on the rise, with a 37 percent increase in cocaine use since 2011. Additionally, cocaine-involved overdose deaths rose 54 percent over the same period, to 6,784 in 2015 from 4,404 in 2012.
That makes identifying a medication treatment even more valuable, Devine said.
“Opioids are a more urgent threat because of the large amount of opiate overdoses,” he said. “I see it that way too, but at the same time cocaine use is on the rise…Cocaine use has significant health effects…I’m glad NIDA has allocated resources to look for effective treatments for cocaine use disorder even in the context of our opiate epidemic.”
The study will be based out of BMC in the South End, but it will include 12 sites all over the country – including Boston, New Jersey, Cincinnati, Los Angeles, Miami, Nevada, Portland (Oregon) and Washington, D.C., among others.
There will be just under 275 participants expected to enroll in the study nationwide, with some getting a placebo and others getting the medication. All will be offered a high standard of care during the 13-week study, and all will have the option to seek treatment for alcohol use, as well – since that is considered a trigger for cocaine use.
Devine and three members of the staff, who are also experts in The Grayken Center for Addiction at BMC, are working on the study, and it is expected to last two years. The study is looking into whether the brain’s serotonin receptors are affected by the diet drug, and whether it reduces the cravings for cocaine in the same way that it reduces cravings for food.
Many researchers believe that pursuing previously approved drugs for addiction treatment is the quickest way to finding ways to help treat substance-use disorders.
[This article has been updated.]