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Drugs for Cocaine Dependence: Not Easy

Leo E. Hollister, MD; Kenneth Krajewski, MD; Terry Rustin, MD; Hamp Gillespie, PhD
Arch Gen Psychiatry. 1992;49(11):905. doi:10.1001/archpsyc.1992.01820110069011.
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To the Editor.—  A recent letter to the Archives reported some modestly favorable results in treating cocaine dependence in methadone-treated patients with buproprion hydrochloride.1 Starting from a different theoretical basis, we embarked on a double-blind evaluation of buproprion vs placebo in patients being treated only for cocaine dependence. Buproprion was chosen because, like cocaine, it is a high-affinity dopamine uptake inhibitor but, unlike cocaine, produces no euphoria or dependence. Thus, it might act to mitigate the actions of cocaine.2We planned to exploit our 28-day inpatient treatment program to monitor the course of treatment in this study for a period of 21 days. Our limited goal was to determine whether buproprion might reduce craving for cocaine during this period. Our patients were largely young (median age, 27 years), male (38 men and eight women), inner city youth who were of low socioeconomic class and borderline intelligence (mean IQ,


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