Bupropion and Contingency Management Combination Could Help Curb Cocaine Use Among OUD Patients
Based on findings from a study published this month in JAMA Network Open, a combination of contingency management programs and bupropion, an antidepressant medication that is also used for smoking cessation, could be a treatment option for curbing cocaine use by patients who are in treatment for opioid use disorder (OUD).
Between March 2015 and September 2019, researchers from Johns Hopkins Medicine conducted a double-blind, randomized study with an adaptive treatment design, meaning that it allowed for modifications to the trial and its statistical procedures while the study was in progress. The study included participation from 80 adults who were receiving methadone for OUD and had self-reported cocaine use within the past 30 days. The average age of the patients was 48, and about two-thirds of the patient population was male.
In the trial, 40 participants received bupropion (up to 300mg twice per day) and 40 received a placebo. The participants were tracked for 30 weeks, being seen 3 times per week and providing urine samples and self-reporting cocaine use. Contingency management initiatives were used, as during the first 26 weeks, participants received monetary incentives for cocaine-negative urine samples, and the reward values increased exponentially throughout the study. Incentive types also varied based on patients’ treatment responses during the first 6 weeks of the study, with patients who ceased cocaine use in the first 6 weeks being offered incentives to prevent relapse, while those who did not stop cocaine use were presented with incentives to promote abstinence.
Overall, study results showed no effect with bupropion versus placebo, but among participants who earned financial incentives for stopping cocaine use, those receiving bupropion were more likely (67%) to not be using cocaine at the end of the study versus those who received the placebo (30%). Meanwhile, among participants who received monetary incentives designed to prevent relapse, there was no additional benefit for those receiving bupropion versus those receiving the placebo.
“Pairing bupropion to prevent cocaine use after the monetary incentives are discontinued may be a promising treatment strategy,” Kelly Dunn, PhD, professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine, said in a news 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.”
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