University of Lynchburg Doctoral Project Assignment Repository
Specialty
Addiction Medicine, Behavioral Medicine
Advisor
Dr. Thomas Colletti
Abstract
Cocaine use disorder (CUD) continues to be a major clinical challenge. There are currently no FDA-approved medications for its treatment, leaving behavioral therapies – especially contingency management – as the gold standard. However, access and implementation barriers often leave patients without consistent care. Interest in psychostimulant medications has grown, with research exploring agents such as modafinil, extended-release amphetamines, and combination regimens like topiramate plus mixed amphetamine salts (MAS-ER). Results so far are mixed: some patients benefit, while others do not, and safety concerns remain. The 2024 ASAM/AAAP Clinical Practice Guideline cautiously supports specialist-supervised psychostimulant use in select cases. While not first-line, psychostimulants may serve as adjunctive options as evidence evolves. Larger, longer trials and integration with behavioral therapies are needed.
Recommended Citation
Yankush K. Psychostimulant Medications for the Treatment of Cocaine Use Disorder: A Clinical Review. University of Lynchburg Doctoral Project Assignment Repository. 2025; 7(3).
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