Treatment of problem cocaine use

There is no well-established and widespread pharmacological treatment available for users with cocaine problems as there is for those suffering from opiate drug problems. Medicines for systematic relief may sometimes be prescribed to cocaine users, but they are usually short-lived and targeted at reducing problems related to cocaine use, for example anxiety or sleep disturbances. Longer-term treatment options for cocaine users are generally carried out within generic drug services. However, overall treatment options for those with cocaine problems appear to be poorly developed (Haasen, 2003). This may be starting to change as some countries begin to develop new treatment responses targeting those with cocaine problems, an example being the development of specific services for crack cocaine use being developed in England (NTA, 2003).

Most of the scientific literature on treating cocaine problems is from American studies and therefore may not reflect the European context. Unfortunately, evaluation of treatment for problem cocaine use remains scarce in the EU, in part simply reflecting the fact that, historically, cocaine problems were encountered relatively rarely by treatment services. One European systematic review of literature on cocaine treatment (Rigter et al., 2004) noted that treatment compliance by problem cocaine users is generally low and relapse rates are high. Some evidence exists that psychotherapy could help to reduce consumption, and no strong evidence was found for the effectiveness of acupuncture for treating cocaine problems. However, overall, these findings should be viewed in the context of simply an absence of a strong European evidence base to guide therapeutic interventions in this area. For example, it is not even clearly known whether specific cocaine-targeted interventions are more effective than enrolling those with cocaine problems in more generic non-drug-specific treatment programmes. Furthermore, it remains an open question whether it is possible to develop a pharmacological treatment for problem cocaine users that can become the ‘standard treatment option’ in the way that methadone and buprenorphine have become standard approaches in the treatment of problem opiate use. It should be noted that there are important differences in the mechanisms by which opiate drugs and stimulants such as cocaine act on the body, which means that therapeutic options to treat drug problems are likely to differ. Some interesting work is currently being conducted in the USA to develop interventions that would temporarily block the effect of cocaine use on the user, and it will be interesting to see whether new treatment options become available from this work in the future.