Section - Quick Takes

03. Pharmacologic Treatments for Cocaine Craving: What Is the Way Forward? A Systematic Review

Published on June 1, 2023 Certification expiration date: June 1, 2026

James Phelps, M.D.

Research Editor - Psychopharmacology Institute

Key Points

Current pharmacologic treatments for cocaine craving are limited in their effectiveness, with no single medication showing consistent efficacy across studies.
Increased dopaminergic signaling from the ventral tegmentum to the nucleus accumbens is hypothesized as the initial common action of all addictive drugs.
Early childhood adversity causes epigenetic changes to neuronal DNA that increase the risk of addiction.
In maternally deprived rats, 2 weeks of daily oxytocin injection as adolescents decreased their inclination to use methamphetamine as adults.

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This Quick Take begins with a disappointing finding, then cruises through some recent brain science, and ends with a research tidbit. So, let’s go. First, in the intended article, Dr. Lassi and colleagues conclude that “current pharmacological treatments for cocaine craving are limited in their effectiveness with no single medication showing consistent efficacy across studies.” Well, if you do see lots of patients with serious craving problems, the list of pharmacologic treatments might provide you with some guidance. So, here it comes. It’s long. Here we go: Amphetamine, biperiden, carbamazepine, levodopa, lisdexamfetamine, lorcaserin, guanfacine, methamphetamine, mirtazapine, pioglitazone, progesterone, and nefazodone. Remember, the review concludes that none of these show “consistent efficacy across studies.”

Hi! Jim Phelps here for the Psychopharmacology Institute. Now, with apologies to addiction specialists, who will know much of this, I ask, “What do we know about the brain changes associated with addiction?” Not surprisingly, this research

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04. Third-Generation Antipsychotics in Patients With Schizophrenia and Nonresponsivity or Intolerance to Clozapine Regimen: What Is the Evidence?

Learning Objectives:

Evaluate the results of a network meta-analysis of treatment options for psychosis in Parkinson’s disease.
Discuss treatment options for insomnia using the recommendations of the American Association for Sleep Medicine and other guides.
Evaluate pharmaceutical options for reducing cocaine craving.
Examine the evidence regarding pharmacologic options after clozapine in treatment-resistant schizophrenia.
Discuss the potential benefits of olanzapine–samidorphan for managing weight gain in patients with first-episode psychosis.

Original Release Date: June 1, 2023

Review and Re-release Date: March 1, 2024

Expiration Date: June 1, 2026

Expert: James Phelps, M.D.

Medical Editor: Melissa Mariano, M.D.

Relevant Financial Disclosures:

James R Phelps declares the following interests:

- McGraw-Hill: Royalties

- W.W. Norton & Co.: Royalties

All of the relevant financial relationships listed above have been mitigated by Medical Academy and the Psychopharmacology Institute.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

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Participants must complete the activity online during the valid credit period that is noted above.

Follow these steps to earn CME credit:

View the required educational content provided on this course page.
Complete the Post Activity Evaluation for providing the necessary feedback for continuing accreditation purposes and for the development of future activities. NOTE: Completing the Post Activity Evaluation after the quiz is required to receive the earned credit.
Download your certificate.

Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement

Medical Academy designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.