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Trial of Modafinil for Cocaine Dependence

Sir

Under Results, please see:

Patient-Reported Use (TLFB, CGO-S)

‘There were no significant modafinil effects on self-reported (TLFB) rates of cocaine use, or on dollars spent on cocaine. CGI-S showed no differences between modafinil and placebo groups in reported cocaine severity or functional impairment.’

Now, although they do not include the actual data in the paper for some reason, this paragraph clearly says that ‘there was no significant modafinil effects on self-reported rates of cocaine use.’ This means that the people in the modafinil and the placebo groups said they used similar amounts of coke during the study. If you read the Abstract of the paper, this fact is left out altogether. It is also left out of the Discussion section of the paper. Yet, the conclusion in the Abstract and in the paper itself says the opposite, ‘Nevertheless, we did find that modafinil significantly improved cocaine abstinence in this randomized, controlled pilot study, suggesting that further research should be conducted to determine whether modafinil might become a first-line treatment for cocaine dependence.’

There was a discrepancy between the urine results that showed some effect of Modafinil and the self-reporting of cocaine use and the money spent on cocaine by the subjects that did not show any effects of modafinil. This result was never mentioned in the Abstract or Discussion of the paper. Thus, people reading the Abstract or the Discussion and Conclusion would miss this result. Apparently your peer reviewers missed this result too. This discrepancy is needed to be explained in the paper because I believe the subjects, who, if they were being dishonest about their coke use, would minimize their use of cocaine in a study like this rather than maximize it, more than the urines in this case. The authors not only made no attempt to explain the discrepancy but ignored it altogether. The peer reviewers should have insisted that the discrepancy be resolved either by showing that the urine tests were erroneous or that the subjects, when asked again about their coke use, admitted lying about it, lying about using more coke than they actually did, something I have never heard of.

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Correspondence to Dan F Umanoff.

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Umanoff, D. Trial of Modafinil for Cocaine Dependence. Neuropsychopharmacol 30, 2298 (2005). https://doi.org/10.1038/sj.npp.1300866

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