Cocaine use by clients in methadone programs: Significance, scope, and behavioral interventions

Condelli, Ward S.; Fairbank, John A.; Dennis, Michael L.; Rachal, J. Valley

doi:10.1016/0740-5472(91)90040-h

Cited by 151 publications

(75 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Certainly, a number of other factors related to treatment, such as exposure to counseling, may have contributed to these effects. It is also important that cocaine abuse persists in many patients on opioid maintenance , and some patients may even initiate cocaine use while on treatment (Condelli et al, 1991;Borg et al, 1999). Finally, it should be noted that even for the lowefficacy -agonists, high doses were required to decrease cocaine self-administration relative to doses that are used clinically to produce analgesia (e.g., the lowest effective dose of butorphanol in the present study, 0.01 mg/kg/h, is equivalent to about 16 mg/day butorphanol in a 70-kg human).…”

Section: Discussionmentioning

confidence: 99%

Effects of μ-Opioid Agonists on Cocaine- and Food-Maintained Responding and Cocaine Discrimination in Rhesus Monkeys: Role of μ-Agonist Efficacy

Negus¹,

Mello²

2002

The Journal of Pharmacology and Experimental Therapeutics

View full text Add to dashboard Cite

-Opioid agonists decrease cocaine self-administration in laboratory studies and cocaine use by many cocaine-and opioiddependent polydrug abusers. To assess the role of -agonist efficacy as a determinant of these effects, this study evaluated cocaine-and food-maintained responding by rhesus monkeys (Macaca mulatta) during chronic treatment with saline or the high-efficacy -agonist fentanyl (0.001-0.01 mg/kg/h), the intermediate-efficacy -agonist morphine (0.032-0.32 mg/kg/h), or the low-efficacy -agonists nalbuphine (0.1-1.0 mg/kg/h) and butorphanol (0.0032-0.032 mg/kg/h). Responding was maintained by cocaine and food under a second order schedule of reinforcement during multiple daily sessions of cocaine and food availability. Saline and each opioid dose were administered continuously for 7 consecutive days during availability of each cocaine dose. All four -agonists produced dosedependent and sustained decreases in cocaine self-administration across a range of cocaine doses (0.0032-0.1 mg/kg/ injection). Nalbuphine and butorphanol produced the greatest decreases in cocaine self-administration and the smallest effects on food-maintained responding. Morphine and fentanyl produced smaller decreases in cocaine self-administration, and undesirable effects precluded evaluation of higher fentanyl and morphine doses. Decreases in cocaine self-administration produced by nalbuphine and butorphanol probably did not reflect a general blockade of cocaine's abuse-related effects, because nalbuphine and butorphanol did not block the discriminative stimulus effects of cocaine in monkeys trained to discriminate 0.4 mg/kg cocaine from saline in a food-reinforced drug discrimination procedure. These results suggest that low-efficacy -agonists may decrease cocaine self-administration to a greater degree and with fewer undesirable effects than highefficacy -agonists.Cocaine abuse continues to be a significant public health problem, and no consistently effective pharmacotherapy has been identified (Mendelson and Mello, 1996). One approach to the evaluation of candidate medications for cocaine abuse has been to examine medication effects on cocaine-maintained responding in drug self-administration procedures. We have proposed that a promising medication might be one that produced dose-dependent and sustained decreases in cocaine self-administration across a broad range of cocaine doses while producing minimal evidence of toxicity (Mello and Negus, 1996). The mixed action opioid buprenorphine appears to approach these criteria. In rhesus monkeys (Macaca mulatta), for example, chronic treatment with buprenorphine decreased cocaine self-administration for up to 120 days while producing smaller changes in responding maintained by food presentation and little other evidence of toxicity in the same monkeys (Mello et al., 1989; for review, see Mello and Mendelson, 1995). The ability of buprenorphine to decrease cocaine self-administration without major toxicity has been confirmed and extended in studies with rodents (Carroll and La...

show abstract

Section: Discussionmentioning

confidence: 99%

Effects of μ-Opioid Agonists on Cocaine- and Food-Maintained Responding and Cocaine Discrimination in Rhesus Monkeys: Role of μ-Agonist Efficacy

Negus¹,

Mello²

2002

The Journal of Pharmacology and Experimental Therapeutics

View full text Add to dashboard Cite

show abstract

“…Cocaine use by methadone-and buprenorphine (suboxone)-maintained patients is reported by many treatment programs (Kosten et al, 1989;Condelli et al, 1991;Gastfriend et al, 1993;Schottenfeld et al, 1993;Bux et al, 1995;Downey et al, 2000;Beswick et al, 2001;Williamson et al, 2006). The concurrent abuse of cocaine and opioids has a number of adverse medical consequences including an enhanced risk for lethal drug overdose (NIDA, 2002).…”

Section: Introductionmentioning

confidence: 99%

Effects of d-Amphetamine and Buprenorphine Combinations on Speedball (Cocaine+Heroin) Self-Administration by Rhesus Monkeys

Mello

Negus

2007

Neuropsychopharmacol

View full text Add to dashboard Cite

The simultaneous i.v. administration of heroin and cocaine, called a 'speedball,' is often reported clinically, and identification of effective pharmacotherapies is a continuing challenge. We hypothesized that treatment with combinations of a monoamine releaser d-amphetamine, and a mu partial agonist, buprenorphine, might reduce speedball self-administration by rhesus monkeys. Speedballs (0.01 mg/kg/inj cocaine + 0.0032 mg/kg/inj heroin) and food (1 g banana-flavored pellets) were available during four daily sessions on a second-order schedule of reinforcement (fixed ratio (FR)2 (variable ratio (VR)16:S)). Monkeys were treated for 10 days with saline or ascending doses of d-amphetamine (0.0032-0.032 mg/kg/h) + buprenorphine (0.075 or 0.237 mg/kg/day) in combination. d-Amphetamine + both doses of buprenorphine produced an amphetamine dose-dependent decrease in speedball self-administration in comparison to the saline treatment baseline (Po0.01-0.001), but food-maintained responding did not change significantly. d-Amphetamine alone (0.032 mg/kg/h) significantly decreased both food (Po0.01) and speedball-maintained responding (Po0.05). During saline control treatment, speedball unit doses of 0.0032 mg/kg/inj cocaine + 0.001 mg/kg/inj heroin were at the peak of the speedball dose-effect curve. Daily treatment with 0.01 mg/kg/h d-amphetamine + 0.237 mg/kg/day buprenorphine produced a significant downward and rightward shift in the speedball dose-effect curve (Po0.01) and no significant effect on food-maintained responding. A significant decrease in speedball self-administration was sustained over 10 days of treatment. These findings are consistent with our previous reports and suggest that medication mixtures designed to target both the stimulant and the opioid component of the speedball may be an effective approach to polydrug abuse treatment.

show abstract

“…In fact, clinical studies have reported that methadone decreases, has no effect, or even increases cocaine use, although differences in methadone dosage may account for the discrepant results (Borg et al, 1999;Brands et al, 2002;Chaisson et al, 1989;Condelli et al, 1991;Hartel et al, 1995;Kidorf and Stitzer, 1993;Kleber, 1994;Kosten et al, 1987;Magura et al, 1991;Maxwell and Shinderman, 1999;Strain et al, 1994). Given these mixed findings, it is surprising that few studies have investigated whether the motivational properties of cocaine are modified by methadone maintenance.…”

Section: Introductionmentioning

confidence: 99%

Methadone Maintenance Reduces Heroin- and Cocaine-Induced Relapse without Affecting Stress-Induced Relapse in a Rodent Model of Poly-Drug Use

Leri

Tremblay

Sorge

et al. 2004

Neuropsychopharmacol

View full text Add to dashboard Cite

Although it is well established that methadone can be an effective treatment for opiate addiction, it is not clear how methadone maintenance affects cocaine use and cravings in individuals who self-administer both opiates and cocaine. In our attempt to explore the effect of methadone maintenance on the effects of cocaine, we first assessed the locomotor stimulatory effects of cocaine in rats maintained on methadone (0, 10, 20, or 30 mg/kg/day, via osmotic minipumps). Chronic methadone elevated baseline locomotion in a dose-dependent manner and did not reduce the direct stimulatory effects of cocaine (5 mg/kg). We then investigated the effects of the highest methadone maintenance dose (30 mg/kg/day) on heroin and cocaine seeking in extinction, and when it was precipitated by exposure to heroin, cocaine, or foot-shock stress in rats trained to self-administer both drugs in the same experimental context (heroin 0.05 mg/kg/inf; cocaine 0.5 mg/kg/inf, eight 3-h sessions each). In tests of reinstatement, rats responded selectively on the appropriate drug-associated lever after priming injections of heroin (0.25 mg/kg) or cocaine (20 mg/kg). Methadone maintenance blocked both cocaine-and heroin-induced reinstatement, but not stress-induced reinstatement, which was not lever selective. These results suggest that although methadone maintenance may not reduce the direct stimulatory effects of cocaine, it has the potential to reduce both spontaneous and cocaine-primed cocaine-seeking behavior.

show abstract

Cocaine use by clients in methadone programs: Significance, scope, and behavioral interventions

Cited by 151 publications

References 37 publications

Effects of μ-Opioid Agonists on Cocaine- and Food-Maintained Responding and Cocaine Discrimination in Rhesus Monkeys: Role of μ-Agonist Efficacy

Effects of μ-Opioid Agonists on Cocaine- and Food-Maintained Responding and Cocaine Discrimination in Rhesus Monkeys: Role of μ-Agonist Efficacy

Effects of d-Amphetamine and Buprenorphine Combinations on Speedball (Cocaine+Heroin) Self-Administration by Rhesus Monkeys

Methadone Maintenance Reduces Heroin- and Cocaine-Induced Relapse without Affecting Stress-Induced Relapse in a Rodent Model of Poly-Drug Use

Contact Info

Product

Resources

About