Department of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA.
Ann N Y Acad Sci. 2010 Feb;1187:76-100. doi: 10.1111/j.1749-6632.2009.05145.x.
A variety of natural and synthetic agents have long been used for stimulant properties, with nontherapeutic use producing multiple waves of stimulant abuse and dependence. The multitude of effects of stimulants exist on continua, and accordingly, here we characterize stimulant abuse/dependence and candidate pharmacotherapies in this manner. Behavioral therapy and medications have been investigated for treatment of stimulant abuse/dependence. Effectiveness of some behavioral interventions has been demonstrated. Most medications studied have been found to lack efficacy. However, an expanding literature supports use of agonist-like medications to treat stimulant abuse/dependence, a strategy effective for nicotine and opiate dependence. The agonist-like conceptualization for stimulant dependence posits that medications with properties similar to that of the abused drug, but possessing lesser abuse liability, will normalize neurochemistry and stabilize behavior, thus reducing drug use. Data suggest use of a range of medications, from l-dopa/carbidopa to amphetamine preparations, depending on the severity of use. This report reviews preclinical, human laboratory, and clinical trial data supporting the agonist-like approach, including risks and benefits. Future directions for development of agonist-like medications are also discussed.
长期以来，各种天然和合成药物一直被用于刺激特性，非治疗性使用会产生多波刺激滥用和依赖。兴奋剂的多种作用存在于连续统一体中，因此，我们以这种方式描述兴奋剂滥用/依赖和候选药物治疗。行为疗法和药物已被用于治疗兴奋剂滥用/依赖。一些行为干预措施的有效性已得到证实。大多数研究的药物都被发现缺乏疗效。然而，越来越多的文献支持使用类似激动剂的药物来治疗兴奋剂滥用/依赖，这一策略对尼古丁和阿片类药物依赖有效。兴奋剂依赖的类似激动剂概念假设，具有类似于滥用药物的特性但滥用风险较低的药物将使神经化学正常化并稳定行为，从而减少药物使用。数据表明，根据使用的严重程度，可使用一系列药物，从左旋多巴/卡比多巴到苯丙胺制剂。本报告回顾了支持类似激动剂方法的临床前、人体实验室和临床试验数据，包括风险和益处。还讨论了类似激动剂药物的未来发展方向。
