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Vol. 298, Issue 1, 1-6, July 2001
Yerkes Regional Primate Research Center (L.L.H., K.M.W.),
Department of Psychiatry and Behavioral Sciences (L.L.H.), and
Department of Pharmacology (L.L.H.), Emory University, Atlanta, Georgia
Despite intensive medication development efforts, no effective
pharmacotherapy for cocaine abuse has demonstrated efficacy for
long-term use. Given the obvious importance of the dopamine transporter
in the addictive properties of cocaine, the development and use of
compounds that target the dopamine transporter represents a reasonable
approach for the pharmacological treatment of cocaine abuse. The
therapeutic approach of replacement or substitute agonist medication
has been successful, as shown with methadone maintenance for heroin
dependence and nicotine replacement for tobacco use. A number of
preclinical studies with dopamine transporter inhibitors provide
evidence that substitute agonists may be used effectively to reduce
cocaine use. Nonhuman primate models of drug self-administration provide a rigorous, systematic approach to characterize medication effectiveness in subjects with a documented history of drug use. Several cocaine analogs and other dopamine transporter inhibitors, including analogs of GBR 12909 and WIN 35,065-2, have been shown to
reduce cocaine self-administration in nonhuman primates. A possible
limitation to the use of selective dopamine transporter inhibitors as
medications is their potential for abuse liability given their
demonstrated reinforcing effects in nonhuman primates. However, limited
reinforcing properties in the context of treatment programs may be
advantageous, contributing to improved patient compliance and enhanced
medication effectiveness. Moreover, pharmacokinetic properties that
result in slow onset and long duration of action may enhance their
effectiveness to reduce cocaine use while limiting their abuse liability.
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