Desipramine in Opioid-Dependent Cocaine Abusers Maintained on Buprenorphine vs Methadone

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Abstract
COMBINED OPIOID and cocaine dependence is associated with major health problems, including medical complications, such as infection with the human immunodeficiency virus or hepatitis and endocarditis, and social issues, such as unemployment and illegal activity. Methadone maintenance programs using individual and group counseling have been found to decrease injection opioid use and subsequent risk for complications such as human immunodeficiency virus.1 However, the rate of cocaine abuse among patients in methadone maintenance programs has increased considerably in the last 10 years.2-5 For instance, rates of cocaine use among those entering treatment averaged 58% in one recent multisite study,6 and rates among those in treatment are as high as 40%.4,5,7,8 Eighty percent of patients using heroin while in a methadone maintenance program and nearly one fifth (20%) of patients otherwise compliant with program rules reported using cocaine at least once during the week prior to being interviewed.8 These findings indicate that methadone maintenance alone does not effectively address cocaine abuse.