Disulfiram versus placebo for cocaine dependence in buprenorphine-maintained subjects: a preliminary trial

Background: We examined the effects of disulfiram versus placebo on cocaine dependence in buprenorphine-maintained subjects. Methods: Opioid and cocaine dependent subjects (n = 20) were induced onto buprenorphine maintenance, then randomized to disulfiram (250 mg q.d.; n = 11) or placebo (n = 9) treatment for 12 weeks. Results: Groups were comparable at baseline on demographic measures and on baseline measures of drug-use severity. Fifteen subjects completed the study, including 8 subjects randomized to disulfiram (72.7%) and 7 subjects randomized to placebo (77.8%). The total number of weeks abstinent from cocaine was significantly greater on disulfiram versus placebo (mean ± SD: 7.8 ± 2.6 vs. 3.3 ± 0.5, p< .05) and the number of days to achieving 3 weeks (24.6 ± 15.1 vs. 57.8 ± 7.7, p< .01) of continuous cocaine abstinence was significantly lower in disulfiram compared with placebo. The number of cocaine-negative urine tests during the trial were also higher on disulfiram (14.7) than on placebo (8.6); furthermore, subjects in the disulfiram group achieved consistently higher rates of cocaine-negative urine tests in each 3-week interval and the increase over time was faster in the disulfiram compared with placebo. Conclusions: This preliminary study suggests the potential efficacy of disulfiram versus placebo for treatment of cocaine dependence in buprenorphine-maintained patients.