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Thompson RG, Oliveto A, Thostenson JD, Wilson MP, McGaugh J, Mancino MJ. Utility of a controlled amphetamine withdrawal paradigm among adults who use methamphetamine: A pilot clinical trial. J Psychopharmacol 2021; 35:1420-1430. [PMID: 34697965 PMCID: PMC10110391 DOI: 10.1177/02698811211050563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The continued increase in prevalence of methamphetamine use in the United States has resulted in a significant increase in the number of patients entering treatment for methamphetamine use. However, no robustly efficacious pharmacologic treatment for methamphetamine use or withdrawal has been identified to date after stopping methamphetamine use. AIMS Given the association between methamphetamine withdrawal and relapse during early treatment, this study tested a controlled d-amphetamine withdrawal paradigm among methamphetamine-using individuals. METHODS Treatment-seeking adults who used methamphetamine (N = 34; 47% female; 100% white) were enrolled in a 4-week, randomized, double-blind, placebo-controlled trial in a residential setting, in which all participants were maintained on d-amphetamine (30 mg BID) during week 1, then half were switched to placebo during weeks 2-3. All participants received placebo during week 4. Outcomes included vital signs, withdrawal, cravings for methamphetamine, mood, and cognition. Bivariate analyses tested treatment group differences on baseline demographic and outcome variables. Repeated measures models examined main and interaction effects of treatment over time. RESULTS/OUTCOMES Participants were successfully randomized and safely stabilized on d-amphetamine. Craving for methamphetamine increased during weeks 2-3 in the placebo group relative to those on d-amphetamine. Interactions with age and heart rate were noted. CONCLUSIONS/INTERPRETATION To our knowledge, this is the first double-blind, placebo-controlled trial measuring pharmacologic effects of abruptly stopping controlled d-amphetamine administration in adults who use methamphetamine. Results support the potential of this withdrawal paradigm to further examine the efficacy of pharmacologic agents in ameliorating methamphetamine withdrawal symptoms.
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Affiliation(s)
- Ronald G Thompson
- Center for Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Alison Oliveto
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeff D Thostenson
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Michael P Wilson
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Janette McGaugh
- Ouachita Behavioral Health and Wellness, Hot Springs, AR, USA
| | - Michael J Mancino
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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2
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Shoptaw S, Trivedi M, Potter JS. If there were an effective pharmacotherapy for cocaine use disorder, what would it do? Addiction 2021; 116:714-715. [PMID: 33269478 PMCID: PMC8011820 DOI: 10.1111/add.15310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/23/2020] [Indexed: 01/13/2023]
Abstract
While thirty years of research into an effective cocaine pharmacotherapy has yielded no treatments, knowledge gained doing this work underscores the importance of rigorous clinical design, of attention to medication adherence and of defining endpoints. The field needs a high-risk/high-reward strategy to engineer new compounds that help people to use less cocaine and to preserve gains made during treatment, particularly during lapse/relapse.
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Affiliation(s)
- Steven Shoptaw
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Madhukar Trivedi
- Department of Psychiatry, University of Texas Southwestern, Dallas, TX, USA
| | - Jennifer S Potter
- Department of Psychiatry, University of Texas Health Science Center, San Antonio, TX, USA
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3
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Pandy V, Wai YC, Amira Roslan NF, Sajat A, Abdulla Jallb AH, Vijeepallam K. Methanolic extract of Morinda citrifolia Linn. unripe fruit attenuates methamphetamine-induced conditioned place preferences in mice. Biomed Pharmacother 2018; 107:368-373. [DOI: 10.1016/j.biopha.2018.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/20/2018] [Accepted: 08/03/2018] [Indexed: 01/07/2023] Open
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4
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Reed B, Butelman ER, Fry RS, Kimani R, Kreek MJ. Repeated Administration of Opra Kappa (LY2456302), a Novel, Short-Acting, Selective KOP-r Antagonist, in Persons with and without Cocaine Dependence. Neuropsychopharmacology 2018; 43:739-750. [PMID: 28857070 PMCID: PMC5809790 DOI: 10.1038/npp.2017.205] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 08/14/2017] [Accepted: 08/27/2017] [Indexed: 12/14/2022]
Abstract
The κ-opioid receptor (KOP-r) system and its endogenous ligands, the dynorphins, are involved in the neurobiological regulation of addictive states, and of mood. There are limited data on the impact of selective KOP-r antagonism in humans on basic biobehavioral functions, or on addictive diseases and mood disorders. Previously studied selective KOP-r antagonists have unusual pharmacodynamic and pharmacokinetic properties (slow development of KOP-r selectivity, extremely long duration of action) that limit translation to human studies. A recently developed selective KOP-r-antagonist, Opra Kappa (LY2456302; CERC-501), has medication-like duration of action, oral bioavailability, and target engagement. The current study is the first investigation of the effects of a KOP-r-antagonist in cocaine-dependent persons in comparison with normal volunteers. In a stress-minimized inpatient setting, we determined the neuroendocrine and neurobehavioral effects of repeated administration of an active dose of Opra Kappa (10 mg p.o. daily, four consecutive days in comparison with an initial baseline day). Healthy volunteers (n=40), persons diagnosed with cocaine dependence in early abstinence (<2 months, EACD) (n=23), and drug-free former cocaine-dependent persons (7-month to 25-year abstinence, DFFCD) (n=7) were studied, with measurements including circulating neuroendocrine hormones, affect, and, in cocaine-dependent persons, cocaine craving. Modest adverse events related to Opra Kappa included pruritus, observed in a subset of individuals. No significant change was observed in serum prolactin levels following Opra Kappa administration, but modest increases in circulating adrenocorticotropic hormone and cortisol were observed. No significant changes were noted in measures of depression or cocaine craving in this stress-minimized setting. Overall, these studies demonstrate that effects of 10 mg Opra Kappa are largely consistent with those predicted for a selective KOP-r antagonist. This medication regimen was tolerable, and is therefore feasible for further studies in cocaine-dependent persons.
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Affiliation(s)
- Brian Reed
- Laboratory of the Biology of Addictive Diseases, Rockefeller University, New York, NY, USA,Laboratory of the Biology of Addictive Diseases, Rockefeller University, Box 171, New York, NY 10065, USA, Tel: 212 327 8247, Fax: 212 327 8574, E-mail:
| | - Eduardo R Butelman
- Laboratory of the Biology of Addictive Diseases, Rockefeller University, New York, NY, USA
| | - Rebecca S Fry
- Laboratory of the Biology of Addictive Diseases, Rockefeller University, New York, NY, USA
| | - Rachel Kimani
- Laboratory of the Biology of Addictive Diseases, Rockefeller University, New York, NY, USA
| | - Mary Jeanne Kreek
- Laboratory of the Biology of Addictive Diseases, Rockefeller University, New York, NY, USA
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5
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Ajonijebu DC, Abboussi O, Russell VA, Mabandla MV, Daniels WMU. Epigenetics: a link between addiction and social environment. Cell Mol Life Sci 2017; 74:2735-2747. [PMID: 28255755 PMCID: PMC11107568 DOI: 10.1007/s00018-017-2493-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/17/2017] [Accepted: 02/21/2017] [Indexed: 01/14/2023]
Abstract
The detrimental effects of drug abuse are apparently not limited to individuals but may also impact the vulnerability of their progenies to develop addictive behaviours. Epigenetic signatures, early life experience and environmental factors, converge to influence gene expression patterns in addiction phenotypes and consequently may serve as mediators of behavioural trait transmission between generations. The majority of studies investigating the role of epigenetics in addiction do not consider the influence of social interactions. This shortcoming in current experimental approaches necessitates developing social models that reflect the addictive behaviour in a free-living social environment. Furthermore, this review also reports on the advancement of interventions for drug addiction and takes into account the emerging roles of histone deacetylase (HDAC) inhibitors in the etiology of drug addiction and that HDAC may be a potential therapeutic target at nucleosomal level to improve treatment outcomes.
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Affiliation(s)
- Duyilemi C Ajonijebu
- Discipline of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, 4000, South Africa
| | - Oualid Abboussi
- Discipline of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, 4000, South Africa.
| | - Vivienne A Russell
- Discipline of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, 4000, South Africa
| | - Musa V Mabandla
- Discipline of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, 4000, South Africa
| | - William M U Daniels
- Discipline of Human Physiology, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, 4000, South Africa
- School of Physiology, University of the Witwatersrand, Johannesburg, South Africa
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6
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Abuse Potential of Oral Phendimetrazine in Cocaine-dependent Individuals: Implications for Agonist-like Replacement Therapy. J Addict Med 2017; 10:156-65. [PMID: 26933876 DOI: 10.1097/adm.0000000000000206] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Phendimetrazine is a prodrug for the monoamine releaser phenmetrazine-a drug with known abuse potential. Preclinical studies suggest that phendimetrazine has limited abuse potential and may have promise as an agonist-like replacement therapy for cocaine dependence. This study evaluated the abuse potential of phendimetrazine in humans. METHODS Nine cocaine-dependent individuals (N = 9) were enrolled to investigate the abuse potential of phendimetrazine and d-amphetamine, using a double-blind, placebo-controlled, within-subject design. Subjective and cardiovascular effects of oral phendimetrazine (35, 70, and 105 mg), d-amphetamine (10, 20, and 30 mg), and placebo were assessed in quasi-random order across 8 sessions lasting for approximately 8 hours each. RESULTS d-Amphetamine (20 and 30 mg) significantly increased cardiovascular measures in a time and dose-related manner, but phendimetrazine did not systematically alter cardiovascular measures. Although d-amphetamine and phendimetrazine significantly increased ratings indicative of abuse potential (eg, drug liking) and stimulant-like effects relative to placebo, these increases were generally small in magnitude, with phendimetrazine producing significant effects on fewer abuse-related measures and at fewer time points than d-amphetamine. CONCLUSIONS These preliminary findings suggest that oral phendimetrazine and d-amphetamine may have limited abuse potential in cocaine-dependent individuals. These findings collectively emphasize that the clinical utility of medications to treat cocaine-use disorders should be weighed carefully against their potential for abuse and diversion, with careful attention paid to evaluating abuse potential in a clinically relevant population of interest. Future studies are needed to further elucidate the potential utility of phendimetrazine as an agonist-like replacement therapy for cocaine dependence.
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Govender T, Choonara YE, Kumar P, Bijukumar D, du Toit LC, Modi G, Naidoo D, Pillay V. Implantable and transdermal polymeric drug delivery technologies for the treatment of central nervous system disorders. Pharm Dev Technol 2016; 22:476-486. [PMID: 27268737 DOI: 10.1080/10837450.2016.1189937] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The complexity of the brain and the membranous blood-brain barrier (BBB) has proved to be a significant limitation to the systemic delivery of pharmaceuticals to the brain rendering them sub-therapeutic and ineffective in the treatment of neurological diseases. Apart from this, lack of innovation in product development to counteract the problem is also a major contributing factor to a poor therapeutic outcome. Various innovative strategies show potential in treating some of the neurological disorders; however, drug delivery remains the most popular. To attain therapeutic drug levels in the central nervous system, large, intolerable systemic doses are generally administered. The major factors responsible for the success maintenance therapy of neurological diseases included controlled and sustained release of neurotherapeutics, reduced frequency of administration, higher bioavailability, and patient compliances. Conventional oral or injectable formulations cannot satisfy all the requirements in many circumstances. This article reviews the therapeutic implantable polymeric and transdermal devices employed in an attempt to effectively achieve therapeutic quantities of drug across the BBB over a prolonged period, to improve patient disease prognosis.
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Affiliation(s)
- Thiresen Govender
- a Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Yahya E Choonara
- a Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Pradeep Kumar
- a Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Divya Bijukumar
- a Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Lisa C du Toit
- a Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Girish Modi
- b Division of Neurosciences, Department of Neurology, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Dinesh Naidoo
- c Division of Neurosciences, Department of Neurosurgery, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Viness Pillay
- a Wits Advanced Drug Delivery Platform Research Unit, Department of Pharmacy and Pharmacology, School of Therapeutic Sciences, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa
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Bolin BL, Lile JA, Marks KR, Beckmann JS, Rush CR, Stoops WW. Buspirone reduces sexual risk-taking intent but not cocaine self-administration. Exp Clin Psychopharmacol 2016; 24:162-73. [PMID: 27254258 PMCID: PMC4896094 DOI: 10.1037/pha0000076] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Impulsive sexual decision-making may underlie sexual risk-taking behavior that contributes to the disproportionately high prevalence of HIV infection among cocaine users. Delay-discounting procedures measure impulsive decision-making and may provide insight into the underlying mechanisms of sexual risk-taking behavior. The anxiolytic drug buspirone reduces delay discounting in rats and blunts the reinforcing effects of cocaine in some preclinical studies suggesting that it might have utility in the treatment of cocaine-use disorders. This study determined whether buspirone mitigates impulsive risky sexual decision-making in cocaine users on a sexual delay-discounting procedure. The effects of buspirone maintenance on the abuse-related and physiological effects of cocaine were also tested. Nine (N = 9) current cocaine users completed a repeated-measures, inpatient protocol in which sexual delay discounting was assessed after 3 days of maintenance on placebo and buspirone (30 mg/day) in counterbalanced order. The reinforcing, subject-rated, and physiological effects of placebo and intranasal cocaine (15 and 45 mg) were also assessed during buspirone and placebo maintenance. Buspirone increased the likelihood of condom use for hypothetical sexual partners that were categorized as most likely to have a sexually transmitted infection and least sexually desirable. Cocaine functioned as a reinforcer and increased positive subjective effects ratings, but buspirone maintenance did not impact these effects of cocaine. Buspirone was also safe and tolerable when combined with cocaine and may have blunted some its cardiovascular effects. The results from the sexual delay-discounting procedure indicate that buspirone may reduce preference for riskier sex in cocaine users. (PsycINFO Database Record
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Affiliation(s)
- B. Levi Bolin
- Department of Behavioral Science, University of Kentucky College of Medicine, 140 Medical Behavioral Science Building, Lexington, KY 40536-0086, U.S.A
| | - Joshua A. Lile
- Department of Behavioral Science, University of Kentucky College of Medicine, 140 Medical Behavioral Science Building, Lexington, KY 40536-0086, U.S.A.,Department of Psychology, University of Kentucky College of Arts and Sciences, 110 Kastle Hall, Lexington, KY 40506-0044, U.S.A.,Department of Psychiatry, University of Kentucky College of Medicine, 3470 Blazer Parkway, Lexington, KY 40509, U.S.A
| | - Katherine R. Marks
- Department of Psychology, University of Kentucky College of Arts and Sciences, 110 Kastle Hall, Lexington, KY 40506-0044, U.S.A
| | - Joshua S. Beckmann
- Department of Psychology, University of Kentucky College of Arts and Sciences, 110 Kastle Hall, Lexington, KY 40506-0044, U.S.A
| | - Craig R. Rush
- Department of Behavioral Science, University of Kentucky College of Medicine, 140 Medical Behavioral Science Building, Lexington, KY 40536-0086, U.S.A.,Department of Psychology, University of Kentucky College of Arts and Sciences, 110 Kastle Hall, Lexington, KY 40506-0044, U.S.A.,Department of Psychiatry, University of Kentucky College of Medicine, 3470 Blazer Parkway, Lexington, KY 40509, U.S.A
| | - William W. Stoops
- Department of Behavioral Science, University of Kentucky College of Medicine, 140 Medical Behavioral Science Building, Lexington, KY 40536-0086, U.S.A.,Department of Psychology, University of Kentucky College of Arts and Sciences, 110 Kastle Hall, Lexington, KY 40506-0044, U.S.A.,Department of Psychiatry, University of Kentucky College of Medicine, 3470 Blazer Parkway, Lexington, KY 40509, U.S.A
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9
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Bardo MT, Compton WM. Does physical activity protect against drug abuse vulnerability? Drug Alcohol Depend 2015; 153:3-13. [PMID: 26091750 DOI: 10.1016/j.drugalcdep.2015.05.037] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 05/05/2015] [Accepted: 05/22/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND The current review examined recent literature to determine our state of knowledge about the potential ability of physical activity serve as a protectant against drug abuse vulnerability. METHODS Both preclinical and clinical studies were examined using either associational or random assignment study designs. In addition to examining drug use as an outcome variable, the potential neural mediators linking physical activity and drug abuse vulnerability were examined. CONCLUSIONS Several important conclusions may be drawn. First, the preclinical evidence is solid in showing that physical activity in various forms is able to serve as both a preventive and treatment intervention that reduces drug use, although voluntary alcohol drinking appears to be an exception to this conclusion. Second, the clinical evidence provides some evidence, albeit mixed, to suggest a beneficial effect of physical activity on tobacco dependent individuals. In contrast, there exists only circumstantial evidence that physical activity may reduce use of drugs other than nicotine, and there is essentially no solid information from random control studies to know if physical activity may prevent initiation of problem use. Finally, both preclinical and clinical evidence shows that various brain systems are altered by physical activity, with the medial prefrontal cortex (mPFC) serving as one potential node that may mediate the putative link between physical activity and drug abuse vulnerability. It is concluded that novel neurobehavioral approaches taking advantage of novel techniques for assessing the physiological impact of physical activity are needed and can be used to inform the longitudinal random control studies that will answer definitively the question posed.
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Affiliation(s)
- Michael T Bardo
- Department of Psychology and Center for Drug Abuse Research Translation, University of Kentucky, Lexington, KY 40536-0509, USA.
| | - Wilson M Compton
- National Institute on Drug Abuse, 6001 Executive Boulevard, MSC 9581, Bethesda, MD 20892-9581, USA
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10
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Olive MF, Cleva RM, Kalivas PW, Malcolm RJ. Glutamatergic medications for the treatment of drug and behavioral addictions. Pharmacol Biochem Behav 2011; 100:801-10. [PMID: 21536062 DOI: 10.1016/j.pbb.2011.04.015] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2010] [Revised: 03/28/2011] [Accepted: 04/15/2011] [Indexed: 12/22/2022]
Abstract
Historically, most pharmacological approaches to the treatment of addictive disorders have utilized either substitution-based methods (i.e., nicotine replacement or opioid maintenance) or have targeted monoaminergic or endogenous opioidergic neurotransmitter systems. However, substantial evidence has accumulated indicating that ligands acting on glutamatergic transmission are also of potential utility in the treatment of drug addiction, as well as various behavioral addictions such as pathological gambling. The purpose of this review is to summarize the pharmacological mechanisms of action and general clinical efficacy of glutamatergic medications that are currently approved or are being investigated for approval for the treatment of addictive disorders. Medications with effects on glutamatergic transmission that will be discussed include acamprosate, N-acetylcysteine, d-cycloserine, gabapentin, lamotrigine, memantine, modafinil, and topiramate. We conclude that manipulation of glutamatergic neurotransmission is a relatively young but promising avenue for the development of improved therapeutic agents for the treatment of drug and behavioral addictions.
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Affiliation(s)
- M Foster Olive
- Department of Psychology, Arizona State University, Tempe, AZ 85287, USA.
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Weinstein AM, Gorelick DA. Pharmacological treatment of cannabis dependence. Curr Pharm Des 2011; 17:1351-8. [PMID: 21524266 PMCID: PMC3171994 DOI: 10.2174/138161211796150846] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 04/05/2011] [Indexed: 11/22/2022]
Abstract
Cannabis is the most frequently used illegal psychoactive substance in the world. There is a significant increase in the number of treatment admissions for cannabis use disorders in the past few years, and the majority of cannabis-dependent individuals who enter treatment have difficulty in achieving and maintaining abstinence. Thus, there is increased need for medications that can be used to treat this population. So far, no medication has been shown broadly and consistently effective; none has been approved by any national regulatory authority. Medications studied have included those that alleviate symptoms of cannabis withdrawal (e.g., dysphoric mood, irritability),those that directly affect endogenous cannabinoid receptor function, and those that have shown efficacy in treatment of other drugs of abuse or psychiatric conditions. Buspirone is the only medication to date that has shown efficacy for cannabis dependence in a controlled clinical trial. Results from controlled human laboratory studies and small open-label clinical trials suggest that dronabinol, the COMT inhibitor entacapone, and lithium may warrant further study. Recent pre-clinical studies suggest the potential of fatty acid amide hydrolase (FAAH) inhibitors such as URB597, endocannabinoid-metabolizing enzymes, and nicotinic alpha 7 receptor antagonists such as methyllycaconitine (MLA).Controlled clinical trials are needed to evaluate the clinical efficacy of these medications and to validate the laboratory models being used to study candidate medications.
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Affiliation(s)
- A M Weinstein
- Department of Medical Biophysics and Nuclear Medicine, Hadassah Medical Organization, EinKerem, Jerusalem 91120, Israel.
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Araujo RB, Balbinot AD, Castro MDGTD, Rocha MRD, Miguel SRPDS, Cohen M, Pedroso RS. Tratamento de exposição a estímulos e treinamento de habilidades como coadjuvantes no manejo do craving em um dependente de crack. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2011; 33:181-8. [DOI: 10.1590/s2237-60892011000300008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Accepted: 12/22/2010] [Indexed: 11/21/2022]
Abstract
OBJETIVO: Tem-se observado um aumento da prevalência de dependentes de crack em amostras clínicas, o que torna necessária a realização de pesquisas quanto a estratégias de tratamento direcionadas a essa clientela. O objetivo deste estudo foi descrever o caso de um dependente de crack internado no qual foram utilizados o tratamento de exposição a estímulos (TEE) e o treinamento de habilidades (TH) como coadjuvantes ao tratamento tradicional. DESCRIÇÃO DO CASO: O paciente é do sexo masculino, 29 anos de idade, solteiro, ensino médio completo. Era dependente de crack e de maconha e fazia uso nocivo de álcool. O paciente já estava internado havia 2 semanas e tinha passado por um protocolo de quatro sessões com entrevista motivacional e prevenção à recaída. Foram feitas seis sessões, ao longo de 2 semanas, de TEE e TH, nas quais o paciente foi exposto in vivo e pela imaginação a estímulos evocadores de fissura, como cachimbo de crack, isqueiro, pedras simuladas, lembranças de locais e amigos associados ao uso da droga. Ele também foi treinado para utilizar estratégias de manejo da fissura. Após 3 meses da alta hospitalar, foi realizado screening toxicológico para avaliar a manutenção de abstinência. O paciente avaliou o uso das técnicas como importante para a manutenção da abstinência após 3 meses da alta e para sua baixa média de fissura pelo crack. COMENTÁRIOS: Talvez o TEE e o TH para manejo da fissura possam ser úteis como coadjuvantes no tratamento de dependentes de crack. Tal uso deve ser avaliado em ensaios clínicos para demonstrar seu real benefício.
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Abstract
Significant public health problems associated with methamphetamine (MA) production and use in the United States have emerged over the past 25 years; however, there has been considerable controversy about the size of the problem. Epidemiological indicators have provided a mixed picture. National surveys of the adult U.S. population and school-based populations have consistently been used to support the position that MA use is a relatively minor concern. However, many other data sources, including law-enforcement groups, welfare agencies, substance abuse treatment program admissions, criminal justice agencies, and state/county executives indicate that MA is a very significant public health problem for many communities throughout much of the country. In this article, we describe (a) the historical underpinnings of the MA problem, (b) epidemiological trends in MA use, (c) key subgroups at risk for MA problems, (d) the health and social factors associated with MA use, (e) interventions available for addressing the MA problem, and (f) lessons learned from past efforts addressing the MA problem.
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Affiliation(s)
- Rachel Gonzales
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, California 90025, USA.
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The Neuroethics of Pleasure and Addiction in Public Health Strategies Moving Beyond Harm Reduction: Funding the Creation of Non-Addictive Drugs and Taxonomies of Pleasure. NEUROETHICS-NETH 2010. [DOI: 10.1007/s12152-010-9074-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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D-cycloserine inhibits the development and the expression of locomotor sensitization to amphetamine in rats. Behav Pharmacol 2010; 21:165-70. [DOI: 10.1097/fbp.0b013e32833a5bcb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hupp CD, Neumeyer JL. Rapid access to morphinones: removal of 4, 5-ether bridge with Pd-catalyzed triflate reduction. Tetrahedron Lett 2010; 51:2359-2361. [PMID: 20495617 DOI: 10.1016/j.tetlet.2010.02.146] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A new synthetic method for the removal of the 4, 5-bridged ether moiety of several opioids has been developed. This process offers a faster, simpler synthetic route to obtain the morphinone scaffold in high yields without the need for protection of the ketone moiety.
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Affiliation(s)
- Christopher D Hupp
- Medicinal Chemistry Program, Alcohol and Drug Abuse Research Center, McLean Hospital, Harvard Medical School, 115 Mill Street, Belmont, Massachusetts 02478
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Edens E, Massa A, Petrakis I. Novel pharmacological approaches to drug abuse treatment. Curr Top Behav Neurosci 2010; 3:343-86. [PMID: 21161760 DOI: 10.1007/7854_2009_29] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The field of pharmacologic addiction treatment is expanding rapidly. While there are currently several FDA-approved medications for nicotine, alcohol, and opiate dependence, research into novel pharmacological approaches for these and additional substances is legion. Each drug of abuse, while sharing a common final neural pathway of increasing dopaminergic tone, has unique and individual characteristics that are important in developing improved and varied treatments. In this chapter, we discuss such research and present the neurobiological underpinnings of these explorations. In general, addiction treatment is focused on four areas: (1) reducing withdrawal discomfort, (2) diminishing cravings, (3) blocking rewarding effects of the drug, and (4) treating comorbidities, such as depression or ADHD. We present current ideas in pharmacologic research for nicotine, alcohol, cannabis, stimulants, and opiates.
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Affiliation(s)
- Ellen Edens
- West Haven Veterans Administration Medical Center, West Haven, CT 06516, USA
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Chiodo KA, Roberts DC. Decreased reinforcing effects of cocaine following 2 weeks of continuous D-amphetamine treatment in rats. Psychopharmacology (Berl) 2009; 206:447-56. [PMID: 19652955 PMCID: PMC2770337 DOI: 10.1007/s00213-009-1622-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 07/11/2009] [Indexed: 12/31/2022]
Abstract
RATIONALE Recent studies have investigated D-amphetamine as a potential agonist medication for cocaine dependence. In rats, a 14-day continuous infusion of D: -amphetamine via osmotic mini-pump has been shown to decrease cocaine-reinforced responding under a progressive ratio (PR) schedule of reinforcement. OBJECTIVES This study was designed to assess the influences of the D-amphetamine treatment dose and self-administered cocaine dose on the magnitude of this effect. MATERIALS AND METHODS Experiment 1: rats were trained to self-administer 1.5 mg/kg/inj cocaine under a PR schedule, then implanted with D-amphetamine mini-pumps for 14 days (days 1-7, 5 mg/kg/day; days 8-14, 7.5 mg/kg/day). Breakpoints were evaluated throughout the treatment period and 14 days post-treatment. Experiment 2: rats were trained to self-administer cocaine under a PR schedule and initial dose-response curves were determined before implantation of D-amphetamine mini-pumps. During the 14-day D-amphetamine (5 mg/kg/day) treatment period, rats self-administered one of four cocaine doses (0.19, 0.38, 0.75, or 1.5 mg/kg/inj). A post-treatment PR dose-response curve and responding under a fixed ratio 1 (FR1) schedule were evaluated after mini-pump removal. RESULTS Experiment 1: breakpoints for 1.5 mg/kg/inj cocaine were unchanged by the increasing dose of D-amphetamine. Experiment 2: the PR dose-response curve was shifted downward after the treatment period in rats that had self-administered 0.19 and 0.38 mg/kg/inj cocaine. In contrast, rats in the 0.75 and 1.5 mg/kg/inj groups demonstrated increased rates of cocaine intake under an FR1 schedule after the treatment period. CONCLUSIONS These data suggest that continuous D-amphetamine treatment attenuates the reinforcing effects of cocaine.
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Affiliation(s)
- Keri A. Chiodo
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, 27157
- Neuroscience Program, Wake Forest University School of Medicine, Winston-Salem, North Carolina, 27157
| | - David C.S. Roberts
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, 27157
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