Modafinil for coke--what about speed?

Dana Beal dana at phantom.com
Wed Jan 12 12:42:28 EST 2005


Posted on Tue, Jan. 11, 2005



Drug offers cocaine addicts hope

Modafinil boosts alertness and may curb impulsiveness, a Penn study 
shows.

By Stacey Burling

Inquirer Staff Writer



After decades of failed attempts to find a drug that helps addicts kick 
cocaine, researchers at the University of Pennsylvania say they have 
finally found a medication that looks promising - a drug currently 
approved to treat sleepiness.

Addicts who took modafinil - used to treat narcolepsy and help pilots 
and night-shift workers stay alert - were about twice as likely to 
avoid cocaine in a given week as those who received a placebo pill, 
according to a small Penn study published this month in the Journal of 
Neuropsychopharmacology.

Patients taking the medicine, marketed as Provigil, were also nearly 
three times as likely as unmedicated counterparts to stay off cocaine 
for a three-week stretch - 33 percent vs. 13 percent, said Charles 
Dackis, chief of psychiatry at Penn's Medical Center-Presbyterian and 
lead investigator of the 62-patient study.

The National Institute on Drug Abuse funded the Penn study and is 
paying for three longer, larger studies as well.

The institute is also funding similar studies of three other medicines: 
baclofen, which is used to treat spastic disorders; topiramate, an 
anti-convulsant; and disulfiram or Antabuse. Ultimately, the medicines 
may be targeted at specific subgroups within the nation's 1.5 million 
cocaine users, said Frank Vocci, director of the division of 
pharmacotherapies and medical consequences of drug abuse.

Modafinil, he said, has qualities that could "propel it to the top." 
Addicts don't mind its side effects and like its "alerting effect." It 
may also reduce impulsiveness, a key factor in addiction.

Given the high percentage of addicts in the study who still used 
cocaine, the drug clearly is not a cure for cocaine addiction, which is 
notoriously difficult to treat. But it may be an important, early step 
toward better drug therapies, said Robert Malcolm, a Medical University 
of South Carolina psychiatrist who heads another of the modafinil 
studies. "Is this drug a home run?" he asked. "No. Maybe it's a single 
or at best a double."

Nonetheless, he and Dackis said modafinil is the most promising drug 
they have seen for cocaine addiction in 20 years.

Dackis said researchers had tried as many as a 100 drugs against 
cocaine during that time with no success.

Modafinil, made by Cephalon Inc. of West Chester, earned $300 million 
in 2003 and has projected sales of $410 million for 2004. The company 
is awaiting word on its request to market the drug for attention 
deficit hyperactivity disorder.

Dackis believes that modafinil helps restore function to the brain's 
pleasure center, which is thrown chemically off balance by long-term 
cocaine use. Addicts often say they don't "feel right" without cocaine. 
"You're craving something that will make you feel better," he said.

Modafinil, he added, "does promote a sense of well being but not 
euphoria and certainly not the rush of euphoria you experience with 
cocaine." One of his previous studies showed that the drug blunted the 
cocaine euphoria. The government lists modafinil as having mild 
potential for abuse. Dackis said he saw no evidence that modafanil is 
addictive.

A middle-aged man who participated in the Penn study believes the drug 
helped him go 14 weeks without cocaine, an unusually long time for him 
during 15 years of addiction.

"I had more energy to stay focused on things I had to do on my job, 
things I had to do at home, at church," he said. "I didn't have time to 
sneak off into North Philly and get lost."

The man, a professional with a college degree who asked that his name 
not be used, said he stopped taking the medicine when the study ended. 
He used cocaine again last week. Now, he has asked his primary-care 
doctor to prescribe modafinil for him. He also plans to go back into 
therapy. "I guess I need that crutch," he said.
Contact staff writer Stacey Burling at 215-854-4944 or 
sburling at phillynews.com.
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