Homeopathy in crack-cocaine craving: randomized, placebo controlled, double-blind study (COCACRACK study)

LETTER TO THE EDITOR

Homeopathy in crack-cocaine craving: randomized, placebo controlled, double-blind study (COCACRACK study)

Ubiratan Cardinalli Adler^I; Ilma Barreto Garcia Saraiva^II; Maria Flora de Almeida^III; Marta Jezierski^IV; Amarilys de Toledo Cesar^V; Edson Zangiacomi Martinez^VI; José Carlos Fernandes Galduróz^VII

^ICentro de Atenção Psicossocial (CAPS II), São Carlos, SP

^IICentro de Atendimento à Pessoa Deficiente (CAPD), Guarulhos, SP

^IIICentro de Referência de Álcool, Tabaco e Outras Drogas (CRATOD), São Paulo, SP

^IVCentro Brasileiro de Informações sobre Drogas (CEBRID), São Paulo, SP

^VFarmácia Homeopática HN-Cristiano, São Paulo, SP

^VIFaculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (FMRP/USP), Ribeirão Preto, SP

^VIIUniversidade Federal de São Paulo (Unifesp), São Paulo, SP

Dear Editor

Current therapeutical options for cocaine craving are still limited, favoring the seek for solutions in Complementary and Alternative Medicine (CAM). Homeopathy is a CAM modality recognized as a medical specialty in Brazil. Homeopathic medicines are produced through sequentially agitated dilutions in decimal (D), centesimal (C) or fifty-millesimal (Quinquagintamillesimal, Q or LM) potencies¹. The efficacy or effectiveness of homeopathic remedies for cocaine dependency has not yet been investigated. We conducted an exploratory randomized, placebo controlled, double-blind 4-week clinical trial aiming at assessing the efficacy and tolerability of the homeopathic medicines Opium and Erythroxylum coca in the complementary treatment of cocaine craving. The study was carried out in São Paulo, in the so called "cracolândia" area, at the Centro de Referência de Álcool, Tabaco e Outras Drogas (CRATOD), with the approval of the Ethics Committee of Universidade Federal de São Paulo (Unifesp). Trial Registration: RBR-67zvt5 (Brazilian Clinical Trials Registry). Patients: Between January and November 2012, 42 patients with a diagnosis of cocaine dependency according to DSM-IV TR criteria were included. The study was interrupted due to low adherence. The majority of participants were unemployed (88%), living in shelters or on the streets of São Paulo downtown area. Interventions: In the homeopathy group patients were treated at CRATOD with conventional treatment and Opium 2 LM, 1 daily sucrose globule melted on the tongue, during the first two weeks, and Erythroxylum coca 2 LM, same dosage, in the following two weeks. Comparison: In the placebo group patients received conventional treatment and 1 sucrose globule a day for the four weeks. During the period of the study, conventional treatment at CRATOD included therapeutic and income generation workshops; motivational groups; group and individual psychotherapies; medical treatment of substance dependency and of clinical/psychiatric comorbidities. Results: Out of the 42 included patients, only 23 (54.8%) returned at least once and were considered for statistical analysis. Twelve patients (52%) were randomized to group 1 (homeopathy) and 11 (48%) to group 2 (placebo). No significant between-group differences were found regarding efficacy (Minnesota Cocaine Craving Scale²) or side effects (Scandinavian Society of Psychopharmacology Side Effect Rating Scale³). Within the homeopathy group, analysis suggests a reduction in the frequency of longer craving episodes and an increased sensation that the medicine contributed to the reduction of craving (final results compared to baseline - Table 1). Larger samples of patients with higher adherence are necessary to evaluate these differences, not observed in the placebo group.

References

Received: 10/1/2013

Accepted: 10/10/2013

• 1. Farmacopeia Homeopatica Brasileira. 2a ed. São Paulo: Editora Atheneu, 1997.
• 2. Halikas JA, Kuhn KL, Crosby R, Carlson G, Crea F. The measurement of craving in cocaine patients using the Minnesota Cocaine Craving Scale. Compr Psychiatry. 1991;32:22-7.
• 3. Lingjaerd O. The UKU side effects rating scale: scale for registration of unwanted effects of psychotropics. Acta Psychiat Scand. 1976;334:81-94

Publication Dates

• Publication in this collection
  07 Jan 2014
• Date of issue
  2013