All major classes of drugs of abuse in our society, including opioids (fentanyl, hydrocodone, and oxycontin) and cocaine, exert their addictive properties through the mesolimbic dopamine system in the brain where the receptors for these chemicals reside. It has been assumed that pharmacologic treatments for cocaine or heroin abuse would have to be somehow different. Despite acting on the same area of the brain, different drugs bond to different receptors within this system, even though the concurrent abuse of both drugs is common.
A new synthetic opioid medication originally developed as a pain reliever has shown great promise for the treatment of "polydrug" abuse involving both cocaine and opioids. This drug, called buprenorphine, is unusual in that it both activates opiate receptors in the brain and then blocks them from further binding with other opiates. Thus, like most opioids, it effectively relieves pain but the risk for overdose is minimal.
Clinical studies found buprenorphine to be effective as a treatment for heroin addiction and to have some advantages over methadone in terms of safety. However, researchers were surprised to discover that buprenorphine was also found to reduce cocaine abuse in individuals who are dependent on both heroin and cocaine. Finding these dual effects by buprenorphine provides new insights into the mechanisms of cocaine and heroin dependence and suggests that these mechanisms may be more closely related than was previously thought.
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