Comparison of Treatments for Cocaine Use Disorder Among Adults: A Systematic Review and Meta-analysis.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of clinical trials
PubMed 33961037 · doi:10.1001/jamanetworkopen.2021.8049
What was done
A systematic review and multilevel random-effects meta-analysis evaluated clinical trials published between 1995 and 2017 assessing interventions for active cocaine use disorder among adults (≥18 years) in outpatient settings. Included trials reported treatment duration, retention, group sizes, and objective urinalysis results for cocaine metabolites. Interventions were clustered into 11 categories: psychotherapy, contingency management programs, placebo, opioids, psychostimulants, anticonvulsants, dopamine agonists, antidepressants, antipsychotics, miscellaneous medications, and other therapies. The primary outcome was the intention-to-treat odds ratio (OR) of a negative urinalysis result for cocaine metabolites at the end of treatment relative to baseline.
What was found
Across 157 studies with 402 treatment groups and 15,842 participants, only contingency management programs were significantly associated with an increased likelihood of a negative urine test result for cocaine metabolites (OR 2.13, 95% CI 1.62–2.80). This association remained significant across all sensitivity analyses. None of the other 10 treatment categories (including all pharmacotherapies and psychotherapy) demonstrated a statistically significant association with objective reductions in cocaine use.
Why it matters
With no approved pharmacotherapies for cocaine use disorder, this meta-analysis highlights contingency management as the only modality with robust meta-analytic evidence for promoting cocaine abstinence, supporting its prioritization in clinical practice and policy.
Limits
The search was restricted to English-language trials published through 2017 with "cocaine" in the title, potentially missing relevant non-titled or newer trials. Outcome assessment was limited to end-of-treatment urinalysis, leaving long-term post-intervention durability unmeasured. Missing data required multiple imputation across heterogeneous trials.
Cited by
- supports There are no pharmacotherapies with proven efficacy for treating crack cocaine or stimulant addiction.