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Braun HM, Taylor JL, Axelrath S. Buprenorphine/naloxone - one formulation that doesn't fit all: a case report. Harm Reduct J 2024; 21:143. [PMID: 39080714 PMCID: PMC11287853 DOI: 10.1186/s12954-024-01054-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 07/03/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND Sublingual buprenorphine, approved for treatment of opioid use disorder since 2002, is most commonly available in co-formulation with naloxone. Naloxone is an opioid antagonist minimally absorbed when sublingual (SL) buprenorphine/naloxone is taken as prescribed; it is thought to reduce potential for misuse via intravenous administration. However, growing data and clinical experience demonstrate that previously accepted assumptions about the pharmacokinetics of these medications may not apply to all patients. CASE PRESENTATION We present a patient whose adverse post-administration side effects on SL buprenorphine/naloxone resolved with transition to SL buprenorphine monoproduct. DISCUSSION Naloxone can be detected in nearly all patients taking SL buprenorphine/naloxone, though with apparent variability in clinical effect. In a minority of patients, naloxone can contribute to adverse and potentially treatment-limiting side effects. Furthermore, the naloxone component is commonly misunderstood by patients and providers and can foster mistrust in the therapeutic relationship if providers are perceived to be withholding a more tolerable formulation. Prescribers should have a low threshold to offer buprenorphine alone when clinically appropriate.
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Affiliation(s)
- Hannan M Braun
- Division of General Internal Medicine, Denver Health and Hospital Authority, 301 W 6th Ave, Denver, 80204, CO, USA.
- Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Jessica L Taylor
- General Internal Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, USA
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2
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Karabulut S. Guanfacine Treatment in a Patient with Intravenous Buprenorphine/Naloxone Misuse. Case Rep Psychiatry 2024; 2024:6359691. [PMID: 38283129 PMCID: PMC10817805 DOI: 10.1155/2024/6359691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/30/2024] Open
Abstract
In this case report, we described a patient admitted with buprenorphine/naloxone (BN) misuse, accompanied by intermittent pregabalin misuse, to self-treat the opioid withdrawal symptoms. We treated the withdrawal symptoms after cessation of BN with guanfacine extended-release (XR). To our knowledge, it has been the first case report describing guanfacine-XR in the treatment of BN misuse. Notably, our patient responded to the treatment with a decrease in withdrawal symptoms without any significant side-effect. Although it is not possible to generalize our findings with a single case report, it might be useful to mark guanfacin-XR as a potential treatment agent for opioid use disorders, including patients with synthetic opioid misuse.
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Affiliation(s)
- Sercan Karabulut
- Centre of Alcohol and Substance Addiction Treatment, Ataturk State Hospital, Antalya, Türkiye
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3
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Namchuk AB, Lucki I, Browne CA. Buprenorphine as a Treatment for Major Depression and Opioid Use Disorder. ADVANCES IN DRUG AND ALCOHOL RESEARCH 2022; 2:10254. [PMID: 36177442 PMCID: PMC9518754 DOI: 10.3389/adar.2022.10254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Rates of major depressive disorder (MDD) are disproportionally high in subjects with opioid use disorder (OUD) relative to the general population. MDD is often more severe in OUD patients, leading to compliance issues with maintenance therapies and poor outcomes. A growing body of literature suggests that endogenous opioid system dysregulation may play a role in the emergence of MDD. Buprenorphine, a mixed opioid receptor agonist/antagonist approved for the treatment of OUD and chronic pain, may have potential as a novel therapeutic for MDD, especially for patients with a dual diagnosis of MDD and OUD. This paper presents a comprehensive review of papers relevant to the assessment of buprenorphine as a treatment for MDD, OUD, and/or suicide compiled using electronic databases per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The principal goal of this literature review was to compile the clinical studies that have interrogated the antidepressant activity of buprenorphine in opioid naïve MDD patients and OUD patients with comorbid MDD. Evidence supporting buprenorphine's superiority over methadone for treating comorbid OUD and MDD was also considered. Finally, recent evidence for the ability of buprenorphine to alleviate suicidal ideation in both opioid-naïve patients and opioid-experienced patients was evaluated. Synthesizing all of this information, buprenorphine emerges as a potentially effective therapeutic for the dual purposes of treating MDD and OUD.
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Affiliation(s)
- Amanda B. Namchuk
- Department of Pharmacology & Molecular Therapeutics, Uniformed Services University, Bethesda, Maryland, 20814, USA
| | - Irwin Lucki
- Department of Pharmacology & Molecular Therapeutics, Uniformed Services University, Bethesda, Maryland, 20814, USA
- Department of Psychiatry, Uniformed Services University, Bethesda, Maryland, 20814, USA
| | - Caroline A. Browne
- Department of Pharmacology & Molecular Therapeutics, Uniformed Services University, Bethesda, Maryland, 20814, USA
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4
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Harun N, Azzalia Kamaruzaman N, Mohamed Sofian Z, Hassan Z. Mini Review: Potential Therapeutic Values of Mitragynine as an Opioid Substitution Therapy. Neurosci Lett 2022; 773:136500. [DOI: 10.1016/j.neulet.2022.136500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 12/29/2021] [Accepted: 01/27/2022] [Indexed: 10/19/2022]
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5
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Kiguchi N, Ko MC. Potential therapeutic targets for the treatment of opioid abuse and pain. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2021; 93:335-371. [PMID: 35341570 PMCID: PMC10948018 DOI: 10.1016/bs.apha.2021.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Although μ-opioid peptide (MOP) receptor agonists are effective analgesics available in clinical settings, their serious adverse effects put limits on their use. The marked increase in abuse and misuse of prescription opioids for pain relief and opioid overdose mortality in the past decade has seriously impacted society. Therefore, safe analgesics that produce potent analgesic effects without causing MOP receptor-related adverse effects are needed. This review highlights the potential therapeutic targets for the treatment of opioid abuse and pain based on available evidence generated through preclinical studies and clinical trials. To ameliorate the abuse-related effects of opioids, orexin-1 receptor antagonists and mixed nociceptin/MOP partial agonists have shown promising results in translational aspects of animal models. There are several promising non-opioid targets for selectively inhibiting pain-related responses, including nerve growth factor inhibitors, voltage-gated sodium channel inhibitors, and cannabinoid- and nociceptin-related ligands. We have also discussed several emerging and novel targets. The current medications for opioid abuse are opioid receptor-based ligands. Although neurobiological studies in rodents have discovered several non-opioid targets, there is a translational gap between rodents and primates. Given that the neuroanatomical aspects underlying opioid abuse and pain are different between rodents and primates, it is pivotal to investigate the functional profiles of these non-opioid compounds compared to those of clinically used drugs in non-human primate models before initiating clinical trials. More pharmacological studies of the functional efficacy, selectivity, and tolerability of these newly discovered compounds in non-human primates will accelerate the development of effective medications for opioid abuse and pain.
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Affiliation(s)
- Norikazu Kiguchi
- Department of Physiological Sciences, School of Pharmaceutical Sciences, Wakayama Medical University, Wakayama, Japan.
| | - Mei-Chuan Ko
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
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6
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Schepis TS, Wastila L, Ammerman B, McCabe VV, McCabe SE. Prescription Opioid Misuse Motives in US Older Adults. PAIN MEDICINE 2021; 21:2237-2243. [PMID: 31816076 DOI: 10.1093/pm/pnz304] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To evaluate age-based differences in prescription opioid misuse (POM) motives and to evaluate substance use and mental and physical health correlates of POM motive categories in older adults. DESIGN Data were from the National Survey on Drug Use and Health (NSDUH), a nationally representative US survey. SETTING The NSDUH is a household survey. SUBJECTS A total of 5,826 US residents with past-year POM; 415 were 50 years and older (7.1%). METHODS Nine POM motives were assessed among those engaged in past-year POM, grouped into three categories: solely physical pain relief, solely non-pain relief, or mixed motives. Prevalence of POM motives were calculated by age group, with logistic models examining age-based differences. Finally, odds of substance use and mental and physical health correlates by motive category were calculated via logistic models in older adults. RESULTS POM motivated solely by physical pain relief increased from 35.1% in young adults to 65.4% in older adults; in older adults, 84.7% of POM episodes involved pain relief as a motive. POM for solely non-pain relief or mixed motives was associated with greater odds, vs pain relief only, of past-year benzodiazepine misuse (odds ratio [OR] = 4.43 and 6.15, respectively), any substance use disorder (OR = 5.57 and 5.60, respectively), and suicidal ideation (OR = 4.05 and 3.56, respectively) in older adults. CONCLUSIONS . POM motives change over the lifespan, with increasing POM for pain relief with aging. Comprehensive nonopioid pain management is needed for those engaged in POM for pain relief, and substance use and mental health treatment are needed for those with non-pain relief motives.
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Affiliation(s)
- Ty S Schepis
- Department of Psychology, Texas State University, San Marcos, Texas
| | - Linda Wastila
- Peter Lamy Center on Drug Therapy and Aging, and Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland
| | - Beth Ammerman
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - Vita V McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan.,St. Joseph Mercy Ann Arbor, St. Joseph Mercy Health System, Ypsilanti, Michigan
| | - Sean Esteban McCabe
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, Ann Arbor, Michigan.,Institute for Research on Women and Gender, University of Michigan, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.,Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan, USA.,Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan, USA
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7
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Nakamura A, Yasufuku K, Shimada S, Aritomi H, Furue Y, Chiba H, Muramoto M, Takase K, Koike K, Matsumoto T, Shimada T, Watari R, Matsuzaki T, Asaki T, Kanemasa T, Fujita M. The antagonistic activity profile of naloxone in μ-opioid receptor agonist-induced psychological dependence. Neurosci Lett 2020; 735:135177. [PMID: 32569809 DOI: 10.1016/j.neulet.2020.135177] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 01/08/2023]
Abstract
Naloxone is a μ-opioid receptor antagonist that has been used to prevent overdose-related respiratory depression and deaths by the illicit use of opioids. Naloxone can also deter the abuse potential of opioids, but little has been reported regarding its antagonistic activity profile against opioid-induced psychological dependence. This study aimed to confirm the antagonistic activity profile of naloxone against several μ-opioid receptor agonists and investigate whether naloxone could affect the psychological dependence induced by widely used μ-opioid receptor agonist, oxycodone. In the Guanosine-5'-o-(3-thio) triphosphate (GTPγS) binding assay, naloxone (30-30,000 nM) inhibited the GTPγS binding induced by oxycodone, hydrocodone, morphine, and fentanyl. It elicited parallel rightward shifts in the concentration-response curves, indicating that naloxone possessed a competitive antagonistic activity profile against these μ-opioid receptor agonists. In the conditioned place preference test, oxycodone (0.01-1 mg/kg, i.v.) produced dose-dependent increases in place preference. The increased place preference induced by oxycodone (1 mg/kg) was significantly attenuated by co-administration of naloxone at a dose of 0.5 mg/kg but not 0.01 mg/kg. Naloxone (0.5 mg/kg, i.v.) also blocked oxycodone (1 mg/kg)-induced dopamine release in nucleus accumbens; however, at a lower dose (0.01 mg/kg), it did not affect the intrinsic dopamine release by oxycodone. These results indicate that the psychological dependence of oxycodone could be antagonized by naloxone, depending on the dose. This characterization might lead to a better understanding of the competitive antagonistic activity profile of naloxone for μ-opioid receptor in the brain.
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Affiliation(s)
- Atsushi Nakamura
- Research Area for Pharmacological Evaluation, Shionogi TechnoAdvance Research Co., Ltd, 1-1, 3-chome, Futaba-cho, Toyonaka, 561-0825, Osaka, Japan
| | - Kana Yasufuku
- Laboratory for Drug Discovery and Disease Research, Shionogi & Co., Ltd., 1-1, 3-chome, Futaba-cho, Toyonaka, 561-0825, Osaka, Japan
| | - Shinji Shimada
- Research Area for Pharmacological Evaluation, Shionogi TechnoAdvance Research Co., Ltd, 1-1, 3-chome, Futaba-cho, Toyonaka, 561-0825, Osaka, Japan
| | - Hiroyuki Aritomi
- Research Area for Pharmacological Evaluation, Shionogi TechnoAdvance Research Co., Ltd, 1-1, 3-chome, Futaba-cho, Toyonaka, 561-0825, Osaka, Japan
| | - Youko Furue
- Research Area for Pharmacological Evaluation, Shionogi TechnoAdvance Research Co., Ltd, 1-1, 3-chome, Futaba-cho, Toyonaka, 561-0825, Osaka, Japan
| | - Hiroki Chiba
- Research Area for Pharmacological Evaluation, Shionogi TechnoAdvance Research Co., Ltd, 1-1, 3-chome, Futaba-cho, Toyonaka, 561-0825, Osaka, Japan
| | - Mami Muramoto
- Research Area for Pharmacological Evaluation, Shionogi TechnoAdvance Research Co., Ltd, 1-1, 3-chome, Futaba-cho, Toyonaka, 561-0825, Osaka, Japan
| | - Kenji Takase
- Laboratory for Drug Discovery and Disease Research, Shionogi & Co., Ltd., 1-1, 3-chome, Futaba-cho, Toyonaka, 561-0825, Osaka, Japan
| | - Katsumi Koike
- Laboratory for Drug Discovery and Disease Research, Shionogi & Co., Ltd., 1-1, 3-chome, Futaba-cho, Toyonaka, 561-0825, Osaka, Japan
| | - Tomoko Matsumoto
- Research Area for Candidate Selection, Shionogi TechnoAdvance Research Co., Ltd, 1-1, 3-chome, Futaba-cho, Toyonaka, 561-0825, Osaka, Japan
| | - Tomoka Shimada
- Research Area for Candidate Selection, Shionogi TechnoAdvance Research Co., Ltd, 1-1, 3-chome, Futaba-cho, Toyonaka, 561-0825, Osaka, Japan
| | - Ryosuke Watari
- Laboratory for Drug Discovery and Development, Shionogi & Co., Ltd., 1-1, 3-chome, Futaba-cho, Toyonaka, 561-0825, Osaka, Japan
| | - Takanobu Matsuzaki
- Laboratory for Drug Discovery and Development, Shionogi & Co., Ltd., 1-1, 3-chome, Futaba-cho, Toyonaka, 561-0825, Osaka, Japan
| | - Toshiyuki Asaki
- Laboratory for Drug Discovery and Disease Research, Shionogi & Co., Ltd., 1-1, 3-chome, Futaba-cho, Toyonaka, 561-0825, Osaka, Japan
| | - Toshiyuki Kanemasa
- Laboratory for Drug Discovery and Disease Research, Shionogi & Co., Ltd., 1-1, 3-chome, Futaba-cho, Toyonaka, 561-0825, Osaka, Japan
| | - Masahide Fujita
- Laboratory for Drug Discovery and Disease Research, Shionogi & Co., Ltd., 1-1, 3-chome, Futaba-cho, Toyonaka, 561-0825, Osaka, Japan.
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8
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Dhagudu NK, Ambekar A, Agrawal A, Rao R, Mishra AK, Jain R, Singh S. Is there enough naloxone to deter the diversion? Effect of concurrent administration of intravenous naloxone on opioid agonist effects of intravenous buprenorphine: A randomised, double‐blind, within‐subject, crossover study among opioid‐dependent subjects. Drug Alcohol Rev 2020; 39:595-603. [DOI: 10.1111/dar.13057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Atul Ambekar
- Department of Psychiatry and National Drug Dependence Treatment Center, National Drug Dependence Treatment CenterAll India Institute of Medical Sciences New Delhi India
| | - Alok Agrawal
- Department of Psychiatry and National Drug Dependence Treatment Center, National Drug Dependence Treatment CenterAll India Institute of Medical Sciences New Delhi India
| | - Ravindra Rao
- Department of Psychiatry and National Drug Dependence Treatment Center, National Drug Dependence Treatment CenterAll India Institute of Medical Sciences New Delhi India
| | - Ashwani K. Mishra
- Department of Psychiatry and National Drug Dependence Treatment Center, National Drug Dependence Treatment CenterAll India Institute of Medical Sciences New Delhi India
| | - Raka Jain
- Department of Psychiatry and National Drug Dependence Treatment Center, National Drug Dependence Treatment CenterAll India Institute of Medical Sciences New Delhi India
| | - Shalini Singh
- Department of Psychiatry and National Drug Dependence Treatment Center, National Drug Dependence Treatment CenterAll India Institute of Medical Sciences New Delhi India
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9
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Harun N, Johari IS, Mansor SM, Shoaib M. Assessing physiological dependence and withdrawal potential of mitragynine using schedule-controlled behaviour in rats. Psychopharmacology (Berl) 2020; 237:855-867. [PMID: 31832720 DOI: 10.1007/s00213-019-05418-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 11/27/2019] [Indexed: 12/23/2022]
Abstract
RATIONALE Kratom is proposed to exhibit therapeutic potential as an opium substitute, but little is known about its dependence-producing profile, particularly of its main psychoactive compound, mitragynine (MG). OBJECTIVES This study examined the dependence-producing effects of MG using operant-scheduled behaviour in rats and investigated the potential therapeutic effect of MG by comparing effects to buprenorphine in morphine-dependent rats using the same schedule-controlled behavioural task. METHODS The effects of acutely administered MG and morphine were determined in rats trained to respond under fixed-ratio (FR) 10 schedule of food reinforcement. Next, the rats were administered MG and morphine twice daily for 14 consecutive days to determine if physiological dependence would develop by examining cessation of drug treatment and following antagonist-precipitated withdrawal. The study then examined the effects of MG substitution to suppress naloxone-precipitated morphine withdrawal effects on scheduled responding. RESULTS Acute doses of MG did not produce dose-related decreases on FR schedules of responding compared to morphine. Unlike morphine, MG-treated rats showed no suppression of response rates following cessation of MG treatment. However, withdrawal effects were evident for MG after precipitation by either naloxone or SR141716A (rimonabant), similar to morphine-treated rats. MG in higher doses (10 and 30 mg/kg) attenuated the naloxone-precipitated morphine withdrawal effects while smaller doses of buprenorphine (0.3 and 1.0 mg/kg) were necessary to alleviate these effects. CONCLUSION The findings suggest that MG does not induce physiological dependence but can alleviate the physical symptoms associated with morphine withdrawal which represent the desired characteristics of novel pharmacotherapeutic interventions for managing opioid use disorder (OUD).
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Affiliation(s)
- Norsyifa Harun
- Centre for Drug Research, Universiti Sains Malaysia, 11800, Penang, Gelugor, Malaysia.
| | - Illa Syafiqah Johari
- Centre for Drug Research, Universiti Sains Malaysia, 11800, Penang, Gelugor, Malaysia
| | - Sharif Mahsufi Mansor
- Centre for Drug Research, Universiti Sains Malaysia, 11800, Penang, Gelugor, Malaysia
| | - Mohammed Shoaib
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, NE2 4HH, UK
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10
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Abstract
This paper is the fortieth consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2017 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (1), the roles of these opioid peptides and receptors in pain and analgesia in animals (2) and humans (3), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (4), opioid peptide and receptor involvement in tolerance and dependence (5), stress and social status (6), learning and memory (7), eating and drinking (8), drug abuse and alcohol (9), sexual activity and hormones, pregnancy, development and endocrinology (10), mental illness and mood (11), seizures and neurologic disorders (12), electrical-related activity and neurophysiology (13), general activity and locomotion (14), gastrointestinal, renal and hepatic functions (15), cardiovascular responses (16), respiration and thermoregulation (17), and immunological responses (18).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, CUNY, 65-30 Kissena Blvd., Flushing, NY, 11367, United States.
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11
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Blazes CK, Morrow JD. Reconsidering the Usefulness of Adding Naloxone to Buprenorphine. Front Psychiatry 2020; 11:549272. [PMID: 33061915 PMCID: PMC7517938 DOI: 10.3389/fpsyt.2020.549272] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 08/25/2020] [Indexed: 01/21/2023] Open
Affiliation(s)
| | - Jonathan D Morrow
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States.,Neuroscience Program, University of Michigan, Ann Arbor, MI, United States
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12
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“They're making it so hard for people to get help:” Motivations for non-prescribed buprenorphine use in a time of treatment expansion. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 71:118-124. [DOI: 10.1016/j.drugpo.2019.06.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/19/2019] [Accepted: 06/23/2019] [Indexed: 01/22/2023]
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13
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Hemby SE, McIntosh S, Leon F, Cutler SJ, McCurdy CR. Abuse liability and therapeutic potential of the Mitragyna speciosa (kratom) alkaloids mitragynine and 7-hydroxymitragynine. Addict Biol 2019; 24:874-885. [PMID: 29949228 DOI: 10.1111/adb.12639] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 04/20/2018] [Accepted: 05/10/2018] [Indexed: 12/17/2022]
Abstract
Kratom, derived from the plant Mitragyna speciosa, is receiving increased attention as an alternative to traditional opiates and as a replacement therapy for opiate dependence. Mitragynine (MG) and 7-hydroxymitragynine (7-HMG) are major psychoactive constituents of kratom. While MG and 7-HMG share behavioral and analgesic properties with morphine, their reinforcing effects have not been examined to date. 7-HMG, but not MG, substituted for morphine self-administration in a dose-dependent manner in the rat self-administration paradigm. Following the substitution procedure, re-assessment of morphine self-administration revealed a significant increase following 7-HMG and a significant decrease following MG substitution. In a separate cohort, 7-HMG, but not MG, engendered and maintained intravenous self-administration in a dose-dependent manner. The effects of pretreatment with nalxonaxine (NLXZ), a μ1 opiate receptor antagonist, and naltrindole (NTI), a δ opiate receptor antagonist, on 7-HMG and morphine self-administration were also examined. Both NLXZ and NTI reduced 7-HMG self-administration, whereas only NLXZ decreased morphine intake. The present results are the first to demonstrate that 7-HMG is readily self-administered, and the reinforcing effects of 7-HMG are mediated in part by μ and δ opiate receptors. In addition, prior exposure to 7-HMG increased subsequent morphine intake whereas prior exposure to MG decreased morphine intake. The present findings indicate that MG does not have abuse potential and reduces morphine intake, desired characteristics of candidate pharmacotherapies for opiate addiction and withdrawal, whereas 7-HMG should be considered a kratom constituent with high abuse potential that may also increase the intake of other opiates.
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Affiliation(s)
- Scott E. Hemby
- Department of Basic Pharmaceutical Sciences, Fred Wilson School of Pharmacy; High Point University; High Point NC USA
| | - Scot McIntosh
- Department of Basic Pharmaceutical Sciences, Fred Wilson School of Pharmacy; High Point University; High Point NC USA
| | - Francisco Leon
- Department of Medicinal Chemistry, College of Pharmacy; University of Florida; Gainesville FL USA
| | | | - Christopher R. McCurdy
- Department of Medicinal Chemistry, College of Pharmacy; University of Florida; Gainesville FL USA
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14
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Abstract
Introduction: The opioid epidemic has become an immense problem in North America, and despite decades of research on the most effective means to treat opioid use disorder (OUD), overdose deaths are at an all-time high, and relapse remains pervasive. Discussion: Although there are a number of FDA-approved opioid replacement therapies and maintenance medications to help ease the severity of opioid withdrawal symptoms and aid in relapse prevention, these medications are not risk free nor are they successful for all patients. Furthermore, there are legal and logistical bottlenecks to obtaining traditional opioid replacement therapies such as methadone or buprenorphine, and the demand for these services far outweighs the supply and access. To fill the gap between efficacious OUD treatments and the widespread prevalence of misuse, relapse, and overdose, the development of novel, alternative, or adjunct OUD treatment therapies is highly warranted. In this article, we review emerging evidence that suggests that cannabis may play a role in ameliorating the impact of OUD. Herein, we highlight knowledge gaps and discuss cannabis' potential to prevent opioid misuse (as an analgesic alternative), alleviate opioid withdrawal symptoms, and decrease the likelihood of relapse. Conclusion: The compelling nature of these data and the relative safety profile of cannabis warrant further exploration of cannabis as an adjunct or alternative treatment for OUD.
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Affiliation(s)
- Beth Wiese
- Department of Psychology, University of Missouri–St. Louis, St. Louis, Missouri
- Department of Anesthesiology, Pain Center, Washington University School of Medicine, St. Louis, Missouri
| | - Adrianne R. Wilson-Poe
- Department of Anesthesiology, Pain Center, Washington University School of Medicine, St. Louis, Missouri
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15
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Kulaksızoğlu B, Kara H, Bodur B, Kuloğlu M. Intravenous buprenorphine/naloxone and concomitant oral pregabalin misuse: a case report. Neuropsychiatr Dis Treat 2018; 14:3033-3035. [PMID: 30519024 PMCID: PMC6233699 DOI: 10.2147/ndt.s179688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Opioid misuse and dependence are major medical and social concerns worldwide. Buprenorphine/naloxone combination (BNC) is a drug that has misuse potential and is used to treat opioid dependence, including buprenorphine and naloxone. Buprenorphine shows its pharmacological effects by binding to opioid receptors. Buprenorphine is a partial agonist and has smaller maximal effects compared to those of full agonists (heroin, methadone). Naloxone is a non-selective opiate antagonist added to buprenorphine for the prevention of intravenous diversion. BNC is used in the treatment of opioid dependence for detoxification and maintenance. The drug should be used as a sublingual film tablet. Pregabalin is used in the treatment of neuropathic pain, epilepsy and anxiety disorders. It is increasingly being reported as possessing a potential for misuse. In this article, we present a case of intravenous BNC and concomitant oral pregabalin misuse that developed in a monitored and treated patient for the reason of opioid dependence.
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Affiliation(s)
- Burak Kulaksızoğlu
- Department of Psychiatry, Akdeniz University School of Medicine, Antalya, Turkey, .,Akdeniz University, Alcohol and Substance Addiction Treatment and Research Center, Antalya, Turkey,
| | - Hüseyin Kara
- Department of Psychiatry, Akdeniz University School of Medicine, Antalya, Turkey, .,Akdeniz University, Alcohol and Substance Addiction Treatment and Research Center, Antalya, Turkey,
| | - Berkan Bodur
- Department of Psychiatry, Akdeniz University School of Medicine, Antalya, Turkey, .,Akdeniz University, Alcohol and Substance Addiction Treatment and Research Center, Antalya, Turkey,
| | - Murat Kuloğlu
- Department of Psychiatry, Akdeniz University School of Medicine, Antalya, Turkey, .,Akdeniz University, Alcohol and Substance Addiction Treatment and Research Center, Antalya, Turkey,
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