Comparative study in mice of flunitrazepam vs. diazepam on morphine withdrawal syndrome

Reducing the time and dose of morphine application used in Marshall and Grahame-Smith method for induction of morphine tolerance and dependence in mice

To induce morphine dependence, different programs have been used and a wide range of behaviors evaluated. A quantitative method based on mice withdrawal jumping behavior has been suggested and later described by Marshall and Grahame-Smith. The purpose of this work was to evaluate different aspects of this method using variations in doses and duration of the protocol. All experiments were done in three parallel methods according to the Marshall protocol: (i) except the dose of morphine (n=20) where we divided all morphine doses by two in first 3 days, (ii) 2-day (M100%-2D, n=14) and (iii) 1-day morphine application (M100%-1D; n=13). The results showed that only 50% doses of morphine that are used according to Marshall method is sufficient to induce morphine dependence whereas they are not able to induce tolerance. On the other hand, M100%-2D protocol could induce morphine tolerance but not dependence whereas M100%-1D group could induce neither morphine tolerance nor dependence in mice. Therefore, these simple modifications in dose and period of morphine application in Marshall method resulted in distinct protocols for induction of morphine tolerance and dependence along with saving of drug and time.

Low efficacy of non-opioid drugs in opioid withdrawal symptoms

Opioid withdrawal, stress or cues associated with opioid consumption can induce opioid craving. If opioids are not available, opioid-dependent patients usually search for alternative drugs. Because several non-opioid drugs stimulate the endogenous opioidergic system, this concept may explain their frequent use by opioid-dependent patients. We hypothesized that non-opioid drugs alleviate opioid withdrawal symptoms and are therefore consumed by opioid addicts. We asked 89 opioid-dependent patients participating in an out-patient opioid maintenance program to estimate the potential of several non-opioid drugs in being able to alleviate opioid withdrawal. We applied a five-point Lickert scale (1 = very good reduction of opioid withdrawal; 5 = no reduction of opioid withdrawal). Patients could also indicate a worsening of opioid withdrawal. Values (mean +/- SD) were: for benzodiazepines, 3.2 +/- 1.1; tricyclic antidepressants, 3.6 +/- 1.1; cannabis, 3.6 +/- 1.0; alcohol, 4.1 +/- 1.1; cocaine, 4.2 +/- 1.1; amphetamine, 4.4 +/- 0.9; nicotine, 4.7 +/- 0.7; and caffeine, 4.9 +/- 0.5. A worsening of opioid withdrawal was reported by 62% of the patients for cocaine, 62% for amphetamine, 50% for caffeine, 37.5% for cannabis, 27% for nicotine, 26% for alcohol, 8% for tricyclic antidepressants and 3% for benzodiazepines. Our study shows a low efficacy of non-opioid drugs in alleviating opioid withdrawal symptoms. The data basis of this study was good and the sample was suitable to be asked for estimations of drug-drug interactions. Of the patients, 26 - 62% even reported a worsening of opioid withdrawal for cannabis, alcohol, cocaine and amphetamine. Only benzodiazepines and tricyclic antidepressants were reported to have a moderate positive effect on opioid withdrawal.

Self-injection of flunitrazepam alone and in the context of methadone maintenance in baboons

Patients in methadone maintenance programs use benzodiazepines to "boost" methadone's subjective effects, and flunitrazepam has been prominent in this context. Self-administration of flunitrazepam (0.001-0.32 mg/kg i.v.) alone and during daily oral methadone administration was evaluated in three baboons. Flunitrazepam maintained self-injection as an inverted U-shaped function of dose at rates higher than those maintained by most other benzodiazepines under the same procedure. In the context of demonstrated physical dependence on 3.2 mg/kg/day p.o. methadone, flunitrazepam doses on the ascending limb of the dose-effect curve maintained greater rates of self-injection than before methadone in two baboons. When the methadone dose decreased to 1.8 mg/kg/day, self-injection remained higher for those baboons and became higher than before methadone for the third baboon. Self-injection remained higher when methadone decreased to 1.0 mg/kg/day, except self-injection of the lowest flunitrazepam dose returned to or below the pre-methadone rate for two baboons. After methadone was discontinued, the dose-effect curve shifted to the right in one baboon but remained to the left in two. Flunitrazepam thus served as a reinforcer alone and in the context of methadone maintenance. Lower doses maintained higher self-injection during and shortly after methadone maintenance. Further research should explore the duration of higher self-injection rates following methadone maintenance.

The effects of diazepam dependence and withdrawal on morphine-induced antinociception and changes in locomotion in male and female rats

Male and female rats were exposed for 3 weeks to diazepam (DZ)-filled or empty capsules (CTR) prior to the daily administration of morphine (MOR, 5 mg/kg, IP) for 5 days. Thereafter, capsules were removed and 48 h later MOR was injected for the next 5 days. The tail-flick latency (TFL) was measured prior to and 15, 30, and 60 min after MOR assessed analgesia. Locomotion (LOC) was determined before and 15 min after injection. Prior to MOR injection (baseline), male rats were more sensitive to the thermal stimulus and were less active than female rats. Daily MOR injections neither affected the baseline TFL nor LOC. Regardless of gender, MOR produced greater analgesia in DZ-dependent and withdrawn rats than in CTR. MOR analgesia was greater in DZ-dependent male than in female rats. Gender differences in MOR analgesia were not of statistical significance in DZ-withdrawn rats. The first dose of MOR produced more depression of LOC in DZ-dependent female than in male rats. Across the time of MOR injections, female DZ-dependent and withdrawn rats were less active than CTR. LOC increased with repeated administration of MOR in all groups of rats. In summary, DZ dependence and withdrawal enhanced MOR analgesia in rats of both sexes. Regardless of chronic treatment, MOR produced more analgesia and less depression of LOC in male than in female rats. It is suggested that a decrease in the function of the GABAergic system plays a role in alteration of MOR analgesia.

Buprenorphine and carbamazepine as a treatment for detoxification of opiate addicts with multiple drug misuse: a pilot study

The growing tendency of opioid addicts to misuse multiple other drugs leads to the investigation of new pharmacostrategies to prevent patients from suffering life-threatening complications and minimize the withdrawal symptoms. The short-term efficacy of a 10-day low-dose buprenorphine/19-day carbamazepine regime (n = 15) to a 14-day oxazepam/19-day carbamazepine regime (n = 12) in an open-labelled 21-day inpatient detoxification treatment was compared. Twenty-seven men and women dependent on opioids and misusing other drugs admitted to a detoxification unit were included in this protocol. Eighteen of 27 patients (67%) completed the study. Four non-completers (27%) received buprenorphine/carbamazepine (four of 15) and five non-completers (42%) were treated with oxazepam/carbamzepine (five of 12), but the difference in the dropout rate between the two treatment strategies was not significant.The buprenorphine/carbamazepine regime provided significantly more effective relief of withdrawal symptoms during the first week of treatment. No severe side effects occurred during treatment in both groups. The present study supports the hypothesis that buprenorphine/carbamazepine is more effective than oxazepam/carbamazepine in rapid opioid detoxification in patients with additional multiple drug misuse and both regimens were safe with no unexpected side effects.

Inhibition of morphine tolerance and dependence by diazepam and its relation to mu-opioid receptors in the rat brain and spinal cord

We have recently observed that concomitant administration of diazepam to morphine pellet implanted rats results in the inhibition of the development of morphine tolerance and dependence. We have now analyzed mu-opioid receptors in rats treated with morphine and diazepam for 5 days by using [3H]-DAMGO for binding studies. Male Sprague-Dawley rats were made tolerant and dependent by subcutaneous (s.c.) implantation of six morphine pellets (two pellets on the first day, and four on the second day). Diazepam (0.25 mg/kg b.wt) was injected once daily intraperitoneally (i.p.) for 5 days. Control rats were implanted with placebo pellets and injected once daily with saline or diazepam (i.p.). Animals were administered s.c. naloxone (10 mg/kg) to induce naloxone-precipitated withdrawal syndrome on the final day of the experiment (day 5). There was an up-regulation of mu-receptor (Bmax increased) in the spinal cord of morphine tolerant (+139%) and dependent (+155%) rats compared to saline treated animals. Diazepam treatment abolished the up-regulation of mu-receptors in spinal cord of morphine treated rats. In the cortex, Bmax was not affected in morphine tolerant or dependent rats but it decreased by 38% in morphine tolerant and 65% in morphine dependent rats treated with diazepam. The Kd of mu-receptors increased in the cortex, striatum and hypothalamus of morphine dependent rats. Diazepam treatment decreased the Kd of mu-receptors in the cortex of morphine tolerant and hypothalamus of morphine-dependent rats. These results suggest that diazepam treatment antagonizes the up-regulation of CNS mu-receptors observed in morphine tolerant rats. In addition, morphine tolerance and dependence may be associated with conversion of mu-opioid receptors to mu-constitutive opioid receptors that are less active, and this conversion is prevented in the brain of animals treated with diazepam.

Effect of alprazolam on opiate withdrawal: a combined behavioural and microdialysis study

Benzodiazepines are commonly abused concurrently with opioids. The pharmacological rationale for this remains unknown. The present study has addressed behaviourally and neurochemically the action of alprazolam on the naloxone-precipitated morphine withdrawal syndrome in male rats. In naloxone (1 mg kg-1 i.p.)-precipitated morphine withdrawn rats, alprazolam (2.5 mg kg-1 s.c.) reduced the severity of the affective component, as measured by squeal on touch hostility, and the physical sequelae of opioid withdrawal. The microdialysis study in anaesthetized rats identified an increase in noradrenaline levels in hippocampal dialysates in rats undergoing naloxone-precipitated opioid withdrawal. Acute treatment with alprazolam (2.5 mg kg-1 s.c.) 20 min before administration of naloxone prevented the previously identified increase in noradrenaline in hippocampal dialysates. The only observable effect alprazolam induced in non-morphine-dependent rats was a 15% reduction in spontaneous locomotor activity. In conclusion, one interpretation of the data suggests that alprazolam decreases the withdrawal syndrome in rats through dampening down the previously identified hyperactivity of the locus coeruleus.

Diazepam pretreatment suppresses morphine withdrawal signs in the mouse

The effect of diazepam on the development of physical dependence on morphine and on the naloxone-precipitated increase in cortical NA turnover were investigated in mice. Co-administration of diazepam (1-4 mg/kg, i.p.) during chronic morphine treatment suppressed the expression of naloxone (3 mg/kg, s.c.)-precipitated withdrawal signs (jumping, exploratory rearing and weight loss). However, a single injection of diazepam (4 mg/kg, i.p.) in morphine-dependent mice did not affect the expression of naloxone-precipitated withdrawal signs. The 3-methoxy-4-hydroxyphenylethyleneglycol (MHPG) level and noradrenaline (NA) turnover (MHPG/NA) in the cerebral cortex were increased by naloxone (3 mg/kg) challenge. These increases in the cortical MHPG level and NA turnover were significantly prevented by co-administration of diazepam (4 mg/kg, i.p.) during chronic morphine treatment. These findings suggest that the co-administration of diazepam during chronic morphine treatment may prevent some neurochemical changes in the central noradrenergic system during chronic morphine treatment, and may suppress the development of physical dependence on morphine. Therefore, the inhibitory action of GABA via benzodiazepine binding sites may play an important role in the development of physical dependence on morphine.

Modification by muscimol of naloxone-precipitated withdrawal symptoms in morphine-dependent mice

1. In morphine-dependent mice, muscimol, a GABAA agonist when given i.p. 30 min before naloxone, attenuated the naloxone-precipitated withdrawal symptoms of jumping, "wet dog" shakes and burrowing, but not body weight loss. 2. Muscimol produced a hypothermic effect which was further aggravated by naloxone.

Inhibition of morphine tolerance and dependence by diazepam and its relation to the CNS Met-enkephalin levels

The effect of diazepam on the development of morphine tolerance and dependence was investigated. Male Sprague-Dawley rats were rendered tolerant and dependent by subcutaneous implantation of six morphine pellets. Diazepam (0.025, 0.25 or 2.5 mg/kg body weight) was once daily injected intraperitoneally into rats starting on the first day of implantation. Antinociception was measured by tail-flick (TF) and hot plate (HP) tests, and the extent of sedation determined by a rotarod test before and one hour after diazepam injections everyday for 5 days. Physical dependence on morphine was assessed by an antagonist-precipitated abstinence syndrome on the fifth day of treatment by injecting naloxone 10 mg/kg subcutaneously. Diazepam (0.025-2.5 mg/kg body weight) did not produce significant antinociception or sedation (sensorimotor impairment) in rats implanted with placebo pellets. Diazepam (0.25 and 2.5 mg/kg) inhibited tolerance to TF antinociception in rats implanted with morphine pellets. Sedation as evidenced by sensorimotor impairment induced by morphine pellet implantation was not influenced by diazepam (0.025-2.5 mg/kg). Diazepam administration (0.25 mg/kg) also decreased the degree of jumping behavior observed following naloxone injection in morphine pellet implanted rats. Serum morphine concentration in morphine-diazepam treated rats was not significantly different from that in morphine-saline treated rats. Finally, a decrease in the Met-enkephalin levels observed in the hypothalamus, hippocampus, cortex and spinal cord of morphine dependent rats was reversed by injecting diazepam along with morphine pellet implantation. These results suggest that diazepam inhibits morphine tolerance and dependence, and also prevents morphine-induced decrease in the CNS Met-enkephalin levels in morphine dependent rats.

Changes in benzodiazepine-receptor activity modify morphine withdrawal syndrome in mice

The effects of different benzodiazepine-receptor ligands on morphine withdrawal were studied: a benzodiazepine agonist, flunitrazepam; a benzodiazepine antagonist, flumazenil; a partial inverse benzodiazepine agonist, Ro 15-4513; and a partial benzodiazepine agonist, Ro 16-6028. Benzodiazepine-ligands were administered i.p. 30 min before naloxone-induced morphine withdrawal syndrome. Jumping behavior was significantly increased by Ro 15-4513 at 10 and 20 mg/kg. Flunitrazepam decreased jumps at all the doses used. Wet dog shakes were decreased by flumazenil and Ro 15-4513 and increased by Ro 16-6028 (only at the highest dose) and flunitrazepam. Our results show that the activation of the benzodiazepine receptor by agonists or high doses of partial agonists decreases jumping and increases wet dog shake behaviour, while the antagonists or the partial inverse agonists enhance jumping and decrease wet dog shakes. These modifications could be interpreted as an attenuation in the severity of the morphine withdrawal syndrome by benzodiazepine agonists.

[3H]-flunitrazepam binding after morphine treatment and under abstinence syndrome

Chronic morphine treatment produced increases in [3H]-flunitrazepam binding in some hippocampal areas of the rat brain. The differences in binding were statistically significant in some cases. Both morphine-dependent and morphine-deprived (abstinence syndrome) animals showed an identical response in binding, which confirms a real, although small, increase in benzodiazepine binding sites in the hippocampus after morphine treatment, that is not affected by a naloxone-induced abstinence syndrome under the conditions studied. These findings support the hypothesis of a morphine-induced up-regulation of benzodiazepine binding sites in the hippocampus. A possible different response in benzodiazepine binding sites 1 and 2 could explain the different findings reported in the literature. Our data suggest that the detected increase in benzodiazepine binding would be mainly due to type 2 binding sites, since the hippocampus has a higher density of this type of benzodiazepine binding sites.

Influence of different benzodiazepines on the experimental morphine abstinence syndrome

The abuse of benzodiazepines by narcotic addicts has been well documented. However, the pharmacological basis of this abuse is not clear. In this study the effects of different benzodiazepines (flunitrazepam: 0.5, 1 and 2 mg/kg; nitrazepam: 0.5, 1, 2.5, 5 and 10 mg/kg; diazepam: 0.5, 1, 2.5, 5 and 10 mg/kg; chlordiazepoxide: 0.5, 1, 2.5, 5 and 10 mg/kg; and triazolam: 0.5, 1 and 2 mg/kg) on the morphine withdrawal syndrome in mice have been compared. Drugs were administered 30 min before naloxone-induced withdrawal. All benzodiazepines tested induced similar changes in some of the signs of morphine abstinence: decreased jumping behavior and increased wet dog shake frequency. Jumping behavior was particularly decreased by triazolam and wet dog shakes were mainly increased by flunitrazepam and nitrazepam. Forepaw treading was reduced by flunitrazepam, diazepam and triazolam, increased by nitrazepam and not changed by chlordiazepoxide. Tremor was effectively reduced by diazepam but less reliably by the other benzodiazepines. Teeth chattering was reduced by flunitrazepam and diazepam. These results indicate that benzodiazepines can interfere with the expression of the morphine withdrawal syndrome.