The hottest topic in cocaine addiction is another drug — a medicine already sold to wake up narcoleptics.
Hundreds of cocaine users are testing whether that legal pill, called modafinil, could help them kick the addiction, and there's early evidence that it may.
Modafinil might also counter the damage that cocaine wreaks on users' brain circuits — damage that in turn fuels the cycle of addiction.
The prospect of that double-whammy has the National Institutes of Health spending $10.8 million researching modafinil as a potential cocaine treatment. Results from the first of three key clinical trials could arrive by year's end.
Scientists are cautious: In a hunt spanning two decades, no one has found a medication to help treat cocaine addiction, and there's no guarantee that modafinil will pan out.
In describing why he's hopeful, one leading researcher recounts the man who accused his drug dealer of selling bad coke before realizing modafinil had kept him from getting high — and several other modafinil testers who told of flushing cocaine down the toilet.
"I've been treating cocaine-addicted patients for something like 25 years, more, and I've never heard of anybody throwing away cocaine," says Dr. Charles Dackis of the University of Pennsylvania.
The study enrolled just 62 people, but the results were significant enough for NIH to fund new research — at Pennsylvania, the University of Texas in Houston, Boston University and other sites — enrolling about 650 cocaine users to see if modafinil really does work.
The main side effect so far: insomnia, not surprising as modafinil is sold today to help narcolepsy patients fend off that neurologic disease's sudden sleep attacks.

Addiction specialists gave it a look because even though modafinil isn't a classic stimulant, it triggered something in the brain to also improve patients' mood, energy levels and ability to concentrate — effects that might counter cocaine withdrawal.
Cocaine is highly addictive: About 16 percent of people who try it become hooked, often rapidly. In 2003, the latest data, the government estimated that more than 1.5 million Americans were dependent on or abusing cocaine, and more reported recently experimenting with it.
Modafinil seems to affect chemicals that in turn regulate dopamine production, a different pathway than cocaine takes in altering normal dopamine, and thus one that might counter it, adds Dackis.
"You can't assume this is going to work," he cautions. But if it pans out, a drug that could help cognition instead of just numb cravings would be "a big benefit in treatment."