Antipsychotic medications for cocaine dependence.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of randomized controlled trials
PubMed 26992929 · doi:10.1002/14651858.CD006306.pub3
What was done
This Cochrane systematic review searched major databases through July 2015 for randomized and controlled clinical trials assessing antipsychotic medications for cocaine dependence. Fourteen studies with 719 participants evaluated risperidone, olanzapine, quetiapine, lamotrigine, aripiprazole, haloperidol, or reserpine against placebo or active controls using standard Cochrane review methodology.
What was found
Antipsychotics reduced treatment dropout compared to placebo across 8 studies (397 participants: RR 0.75, 95% CI 0.57 to 0.97, moderate-quality evidence). No significant differences were observed for cocaine use during treatment (2 studies, 91 participants: RR 1.02, 95% CI 0.65 to 1.62), continuous abstinence (3 studies, 139 participants: RR 1.30, 95% CI 0.73 to 2.32), side effects (6 studies, 291 participants: RR 1.01, 95% CI 0.93 to 1.10), or craving (4 studies, 240 participants: RR 0.13, 95% CI -1.08 to 1.35), all rated low quality. In a single trial of 60 participants, quetiapine reduced weekly cocaine grams (MD -0.54, 95% CI -0.92 to -0.16), weekly cocaine spending (MD -$53.80, 95% CI -97.85 to -9.75), and craving (MD -1.23, 95% CI -2.19 to -0.27).
Why it matters
There is currently no evidence supporting the clinical use of antipsychotic medications to treat cocaine dependence.
Limits
The total sample size was small (719 participants across 14 trials). Risk of attrition bias was high in 40% of studies, and risk of selection, performance, and detection bias was unclear in 75% to 80%. Key clinical outcomes—such as side effects, craving, and cocaine use during treatment—were frequently omitted, limiting meta-analytic synthesis.
Cited by
- supports There are no pharmacotherapies with proven efficacy for treating crack cocaine or stimulant addiction.