Methylphenidate Effects in Cocaine-Dependent Patients

[pharmapsyche]

Laboratory measures of methylphenidate effects
in cocaine-dependent patients receiving treatment
by
Roache JD, Grabowski J, Schmitz JM, Creson DL, Rhoades HM
Substance Abuse-Medications Development Research Center,
Department of Psychiatry & Behavioral Sciences,
School of Medicine,
University of Texas Mental Sciences Institute,
Houston, USA.

Two experiments examined the effects of methylphenidate in male and female patients enrolled in an outpatient treatment program for primary cocaine dependence. The first study was a component of a double-blind efficacy trial wherein 57 patients were first tested in a human laboratory for their initial responsiveness to medication. Patients were randomly assigned to receive either placebo or methylphenidate treatment and received their first dose in the human laboratory environment before continuing in outpatient treatment. Methylphenidate was given as a 20-mg sustained-release dose (twice daily) plus an additional 5-mg immediate-release dose combined with the morning dose. Methylphenidate increased heart rate and subjective ratings; however, the subjective effects were primarily of a "dysphoric" nature, and significant effects were limited to increases in anxiety, depression, and anger on the Profile of Mood States; shaky/jittery ratings on a visual analog scale; and dysphoria on the lysergic acid diethylamide (LSD) scale of the Addiction Research Center Inventory. Methylphenidate did not increase cocaine craving nor ratings suggesting abuse potential (i.e., Morphine-Benzedrine Group or drug-liking scores, etc.). None of the drug effects observed in the human laboratory was of clinical concern, and no subject was precluded from continuing in the outpatient study. After outpatient treatment completion, 12 patients were brought back into a second double-blind human laboratory study in which three doses (15, 30, and 60 mg) of immediate-release methylphenidate were administered in an ascending series preceded and followed by placebo. Methylphenidate produced dose-related increases in heart rate, subjective ratings of shaky/jittery, and LSD/dysphoria without significantly altering cocaine craving or stimulant euphoria ratings. These results suggest that stimulant substitution-type approaches to the treatment of cocaine dependence are not necessarily contraindicated because of cardiovascular toxicity or medication abuse potential. However, they also suggest that the subjective effects of methylphenidate may not be positive enough for an adequate replacement approach.

[Forthesevenlakes]

Interesting results, were the researchers trying to pilot a program where methylphenidate would be used to either taper off or replace cocaine or amphetamine, much like methadone is used for heroin? If some more adequate and reinforcing substitute were found, say a piperazine, or a compound with binding strengths somewhere in between methylphenidate and amphetamine, perhaps this would be incredibly useful in treatment. I'd really like to read up more on studies of this nature, can anyone suggest some articles or links for me? I could UTFSE but I'd like some articles that people have already perused and can vouch for their validity and quality.

[Richard_smoker]

It sounds like methylphenidate made everyone feel like shit! That's what I read anyway. AFAIK, the only treatment that's been used for what you're talking about is welbutrin. Possibly strattera, but I've never actually heard of anyone doing it.

[pharmapsyche]

In the article, they are stateing that snorting methylphenidate (ritilan) it much like snorting cocaine, which is crazy! I'm not sure that exactly they are trying to "use methylphenidate for cocaine addiction withdrawl treatment" in the same way they do with methadone for herion addicts, but that is a good question. Wouldn't it be cool if they did find something closely related to both drugs, methylphenidate and cocaine, that would help addicts...i could see it happening sooner or later with all the teconlogy and knowlege we have now-a-days. I've never heard of anyone using piperazine, maybe you could tell me more about that? If you visit biopsychiatry.com, you'll find information on this subject. It's a great website, hope you check it out!

[Richard_smoker]

I didn't catch that from the article. In fact, I didn't even read anything about snorting the methylphenidate. The paper just says that the drugs were administered and it was assumed that they were talking about oral administration. There's no reason to include time-released products when discussing intranasal administration anyway, right? I think it's possible that methylphenidate was explored using cocaine addicted humans because both drugs are known to work in the same manner (i.e. inhibiting reuptake of catecholamines), however, it appears that there is a fundamental difference in the eyes of the addicts... as I said, sounds like ritalin made everyone feel like shit.

[Forthesevenlakes]

I dont even know much about how piperazines work, except that on double blind studies, BZP is supposed to be indistinguishable from methamphetamine. So I'm thinking if the piperazine structure was tweaked with (pun intended) to bind a little less strongly, it could create a long-lasting craving reducer that still carried a bit of a rush. Also it seems unlikely that they'd have anyone snort methylphenidate, but that could be a bit of a confound in the experiment since cocaine addicts are accustomed to that route of administration, and so may have expectations based partially around the very act of snorting, NOT swallowing. SWIM has railed ritalin and not felt like shit, not great either, but then SWIM is not a seasoned cokehead and has little basis for comparison. In SWIM's opinion more just like a disappointing version of adderall. I am going to check out that biopsychiatry.com site though.

[kaliwraith]

SWIM finds methylphenidate to be extremely synergistic with cocaine - 126 mg orally did not produce euphoria, but SWIM ended up feeling the same level effects from 40 mg IV hits as he usually enjoys from 100-130 mg of purified cocaine. Makes shooting much more worth it.