Pharmacotherapy of addiction

Abstract

Addiction is a very serious and very costly public health problem. FDA-approved medications are available for alcohol, nicotine, and opiate addiction but not for stimulants or cannabis addictions. The focus of this chapter is on the medications to treat illicit substances, mainly heroin, stimulants, and cannabis. Currently, psychotherapy is still the primary mode of treatment for stimulants and cannabis addiction; however, relapse rates remain high. The search for effective pharmacological treatments has yielded some positive signals in proof of concept trials. Medications that are being tested in confirmatory trials for stimulants addiction include bupropion, topiramate, modafinil, disulfiram, ondansetron, and methylphenidate. For cannabis addiction there have been proof of concept trials that have shown efficacy, such as buspirone, nefazadone, and marinol. Early preclinical and clinical data suggest that some new molecular entities would be promising for multiple addictions, e.g., CB1 antagonists, D3 partial agonists, and CRF antagonists.