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Could a narcolepsy wake-up drug also fight cocaine addiction? Researchers say it may, and addicts are testing the pill.

Provigil may aid cocaine addicts

BY LAURAN NEERGAARD
Associated Press, April 26, 2006

WASHINGTON - The hottest topic in cocaine addiction is another drug -- a medicine already sold to wake up narcoleptics.

Hundreds of cocaine users are testing whether that legal pill, called modafinil, could help them kick the addiction, and there's early evidence that it may.

In addition to blunting cocaine's notorious cravings, modafinil might also counter the damage that cocaine wreaks on users' brain circuits -- damage that, in turn, fuels the cycle of addiction.

The prospect of that double-whammy has the National Institutes of Health spending $10.8 million researching modafinil as a potential cocaine treatment.

Results from the first of three key clinical trials could arrive by year's end.

Scientists are cautious.

In a hunt spanning two decades, no one has found a medication to help treat cocaine addiction, and there's no guarantee that modafinil will pan out.

But for Dr. Nora Volkow, director of the NIH's National Institute on Drug Abuse, the narcolepsy medicine tops the list of promising potential therapies.

It may help restore proper function of a crucial brain chemical, dopamine, that addiction hijacks.

And in describing why he's hopeful, one leading researcher recounts the man who accused his drug dealer of selling bad coke before realizing modafinil had kept him from getting high -- and several other modafinil testers who told of flushing cocaine down the toilet.

''I've been treating cocaine-addicted patients for something like 25 years, more, and I've never heard of anybody throwing away cocaine,'' said Dr. Charles Dackis, of the University of Pennsylvania.

He led a pilot study that suggested modafinil more than doubled cocaine addicts' chances of going cocaine-free for a period of at least three weeks.

That study enrolled just 62 people, but the results were significant enough for the NIH to fund new research -- at Pennsylvania, the University of Texas in Houston, Boston University and other sites -- enrolling about 650 cocaine users to see if modafinil really does work.

The main side effect so far: insomnia, not surprising as modafinil is sold today to help narcolepsy patients fend off that neurological disease's sudden sleep attacks.

Addiction specialists gave it a look because even though modafinil isn't a classic stimulant, it triggered something in the brain to also improve patients' mood, energy levels and ability to concentrate -- effects that might counter cocaine withdrawal. Then came the surprises:

• Cocaine intensely stimulates the brain's pleasure centers, producing not just a ''buzz'' or a ''rush,'' but outright euphoria. In a small safety study to ensure that modafinil didn't make cocaine worse, some users found the pill blocked that high.
• Modafinil seems to increase activity in the prefrontal cortex, the brain's decision-making command center and the spot that allows reasoning to override impulse or emotion. Cocaine reduces activity in that key brain region, making it even harder for would-be quitters to ignore cravings.
• Modafinil also increases the ability to think strategically, a means of weighing variables and risks to make decisions, says Frank Vocci, NIDA's pharmacotherapy chief.

Cocaine is highly addictive: About 16 percent of people who try it become hooked.

In the latest data, from 2003, the government estimated that more than 1.5 million Americans were dependent on or abusing cocaine, and more reported recently experimenting with it.