Will hope triumph over experience in pharmacotherapy research on cocaine use disorder?

‘Resurgent’, ‘twin’ or ‘silent’ epidemic? A select data overview and observations on increasing psycho-stimulant use and harms in North America

“…A very recent RCT utilizing injectable naltrexone combined with bupropion for methamphetamine use disorder found a relatively higher response rate for the treatment intervention compared to placebo controls, yet a low overall treatment effect (11.1%) [99]. A few select medications (e.g., n-acetyl-cysteine, methylphenidate, modafinil, dexamphetamine) have shown some 'promise' for psycho-stimulant dependence treatment, or 'maintenance'-type interventions, yet require further rigorous investigation and substantially improved evidence for clearer assessment; while some observers are more optimistic regarding the therapeutic potential or prospects of medications-based treatment for psychostimulants, others do not expect major advances on the horizon of psycho-stimulant treatment in the foreseeable future [100][101][102]. The current standard of care for psycho-stimulant dependence treatment primarily involves on psycho-social interventions; however, their effectiveness is limited and commonly does not produce better outcomes than usual care [47,103,104].…”

How can we optimally channel therapeutic optimism to advance pharmacotherapy research on cocaine use disorder?

“…Advancing science and treatment requires both a critical look back to learn from past successes and failures and an optimistic look forward focusing on the most promising avenues to pursue, notwithstanding that the road may be long and winding, as suggested by Humphreys [17]. Hence, we urge researchers not to give up hope in the journey towards identifying efficacious treatments for CUD.…”