- The Washington Times - Sunday, August 29, 2004

NEW YORK (AP) — Can Prozac help you kick cocaine? Can Ritalin? How about a blood—pressure pill or medicine for muscle spasms?

If you’re an alcoholic, could you get help staying sober by taking an anti-nausea drug used by cancer patients?

Scientists are exploring those questions. In fact, in the field of addiction medicine, one of the hottest sources of new drugs is old drugs.

Despite years of research, no drug has been approved in the United States for treating cocaine dependence. To find such a treatment, the National Institute on Drug Abuse (NIDA) is sponsoring human studies of 21 medicines already on the market for something else. That is about two-thirds of all the potential cocaine drugs being tested in people, says Frank Vocci, director of NIDA’s pharmacotherapy division.

At the National Institute on Alcohol Abuse and Alcoholism (NIAAA), nearly all the potential alcoholism drugs tested in people under institute sponsorship in the past 10 years had been approved for some other use, said Raye Litten, co-leader of the institute’s medications development team.

Although the strategy is hardly new, “it’s been going on maybe just a bit below the radar screen” for most of the public, Mr. Vocci said.

It can certainly work. In 1997, for example, the government approved a smoking cessation pill called Zyban, which was in fact the older antidepressant Wellbutrin.

To be sure, researchers haven’t given up on developing new drugs. Most NIAAA-funded drug studies for alcoholism that are in early stage testing — not yet tried on people — are new drugs, Mr. Litten said.

But the notion of examining current drugs for addiction-breaking potential holds several advantages. It is a lot cheaper to get federal approval for a new use of an old drug than to bring a completely new medicine to market. Experience with an existing drug gives an idea of its safety and dose range for possible anti-addiction effects, Mr. Vocci said.

He and others caution that people who happen to have medications on hand that show promise in such studies shouldn’t give them to friends and family with addiction problems. That must be left to professionals. Scientists also say that even effective anti-addiction medicines usually can’t work by themselves, but must be used along with non-drug therapy.

The most straightforward approach to testing an existing drug is to follow its approved purpose, but in a different way. For example, some scientists are studying how to prolong the effects of naltrexone, now usually given as a daily pill for treating dependence on alcohol or opiates such as heroin and morphine.

Dr. David Gastfriend of Massachusetts General Hospital and Harvard Medical School and other researchers have reported that specially formulated naltrexone helped alcoholic men cut down on their drinking for a month when they received the drug as a monthly shot.

“The pill requires a daily awareness that this is a dangerous disease and a rational decision to take the pill,” Dr. Gastfriend said. “The problem with this illness is that on any given day, a person can feel, ‘No, it would be better if I could drink.’ So you take the pill the first day, and you have to make 29 more decisions” the rest of the month.

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