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Donlon J, Kumari P, Varghese SP, Bai M, Florentin OD, Frost ED, Banks J, Vadlapatla N, Kam O, Shad MU, Rahman S, Abulseoud OA, Stone TW, Koola MM. Integrative Pharmacology in the Treatment of Substance Use Disorders. J Dual Diagn 2024; 20:132-177. [PMID: 38117676 DOI: 10.1080/15504263.2023.2293854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
The detrimental physical, mental, and socioeconomic effects of substance use disorders (SUDs) have been apparent to the medical community for decades. However, it has become increasingly urgent in recent years to develop novel pharmacotherapies to treat SUDs. Currently, practitioners typically rely on monotherapy. Monotherapy has been shown to be superior to no treatment at all for most substance classes. However, many randomized controlled trials (RCTs) have revealed that monotherapy leads to poorer outcomes when compared with combination treatment in all specialties of medicine. The results of RCTs suggest that monotherapy frequently fails since multiple dysregulated pathways, enzymes, neurotransmitters, and receptors are involved in the pathophysiology of SUDs. As such, research is urgently needed to determine how various neurobiological mechanisms can be targeted by novel combination treatments to create increasingly specific yet exceedingly comprehensive approaches to SUD treatment. This article aims to review the neurobiology that integrates many pathophysiologic mechanisms and discuss integrative pharmacology developments that may ultimately improve clinical outcomes for patients with SUDs. Many neurobiological mechanisms are known to be involved in SUDs including dopaminergic, nicotinic, N-methyl-D-aspartate (NMDA), and kynurenic acid (KYNA) mechanisms. Emerging evidence indicates that KYNA, a tryptophan metabolite, modulates all these major pathophysiologic mechanisms. Therefore, achieving KYNA homeostasis by harmonizing integrative pathophysiology and pharmacology could prove to be a better therapeutic approach for SUDs. We propose KYNA-NMDA-α7nAChRcentric pathophysiology, the "conductor of the orchestra," as a novel approach to treat many SUDs concurrently. KYNA-NMDA-α7nAChR pathophysiology may be the "command center" of neuropsychiatry. To date, extant RCTs have shown equivocal findings across comparison conditions, possibly because investigators targeted single pathophysiologic mechanisms, hit wrong targets in underlying pathophysiologic mechanisms, and tested inadequate monotherapy treatment. We provide examples of potential combination treatments that simultaneously target multiple pathophysiologic mechanisms in addition to KYNA. Kynurenine pathway metabolism demonstrates the greatest potential as a target for neuropsychiatric diseases. The investigational medications with the most evidence include memantine, galantamine, and N-acetylcysteine. Future RCTs are warranted with novel combination treatments for SUDs. Multicenter RCTs with integrative pharmacology offer a promising, potentially fruitful avenue to develop novel therapeutics for the treatment of SUDs.
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Affiliation(s)
- Jack Donlon
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Pooja Kumari
- Community Living Trent Highlands, Peterborough, Canada
| | - Sajoy P Varghese
- Addiction Recovery Treatment Services, Veterans Affairs Northern California Health Care System, University of California, Davis, Sacramento, California, USA
| | - Michael Bai
- Columbia University, New York, New York, USA
| | - Ori David Florentin
- Department of Psychiatry, Westchester Medical Center, Valhalla, New York, USA
| | - Emma D Frost
- Department of Neurology, Cooper University Health Care, Camden, New Jersey, USA
| | - John Banks
- Talkiatry Mental Health Clinic, New York, New York, USA
| | - Niyathi Vadlapatla
- Thomas Jefferson High School for Science and Technology, Alexandria, Virginia, USA
| | - Olivia Kam
- Stony Brook University Renaissance School of Medicine, Stony Brook, New York, USA
| | - Mujeeb U Shad
- Department of Psychiatry, University of Nevada Las Vegas, Las Vegas, Nevada, USA
| | - Shafiqur Rahman
- Department of Pharmaceutical Sciences, College of Pharmacy, South Dakota State University, Brookings, South Dakota, USA
| | - Osama A Abulseoud
- Department of Psychiatry and Psychology, Alix School of Medicine at Mayo Clinic, Phoenix, Arizona, USA
| | - Trevor W Stone
- Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Maju Mathew Koola
- Department of Psychiatry and Behavioral Health, Cooper University Health Care, Cooper Medical School of Rowan University, Camden, New Jersey, USA
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Shamabadi A, Arabzadeh Bahri R, Karimi H, Heidari E, Akhondzadeh S. Emerging pharmacotherapy for the treatment of cannabis use disorder. Expert Opin Pharmacother 2024; 25:695-703. [PMID: 38717605 DOI: 10.1080/14656566.2024.2353638] [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: 02/16/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION About one-fifth of cannabis users, the most commonly used illicit substance, have cannabis use disorder (CUD). Psychiatric disorders and suicide are more common in these patients, and the disability-adjusted life years were reported to be 0.69 million. Pharmacotherapy for CUD is an unmet public health need, as current evidence-based therapies have limited efficacy. AREAS COVERED After explaining the pathophysiology of CUD, the effects of emerging pharmacological interventions in its treatment obtained from randomized controlled trials were reviewed in light of mechanisms of action. Superiority over control of cannabidiol, gabapentin, galantamine, nabilone plus zolpidem, nabiximols, naltrexone, PF-04457845, quetiapine, varenicline, and topiramate were observed through the cannabinoid, glutamatergic, γ-aminobutyric acidergic, serotonergic, noradrenergic, dopaminergic, opioidergic, and cholinergic systems. All medications were reported to be safe and tolerable. EXPERT OPINION Adding pharmacotherapy to psychotherapy is the optimal treatment for CUD on a case-by-case basis. Drug development to add to psychotherapy is the main path, but time and cost suggest repurposing and repositioning existing drugs. Considering sample size, follow-up, and effect size, further studies using objective tools are necessary. The future of CUD treatment is promising.
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Affiliation(s)
- Ahmad Shamabadi
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Razman Arabzadeh Bahri
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hanie Karimi
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Heidari
- Department of Pharmacy, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Akhondzadeh
- Psychiatric Research Center, Roozbeh Psychiatric Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Lake S, Haney M, Cooper ZD. Sex differences in the subjective and reinforcing effects of smoked cannabis. Addict Biol 2023; 28:e13301. [PMID: 37369126 PMCID: PMC10300354 DOI: 10.1111/adb.13301] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/07/2023] [Accepted: 04/30/2023] [Indexed: 06/29/2023]
Abstract
Preclinical studies have shown sex-based differences in the reinforcing effects of cannabinoid 1 receptor agonists such as delta-9-tetrahydrocannabinol (THC). This study sought to test whether these sex differences translate to humans by assessing the subjective and reinforcing effects of smoked cannabis in male and female volunteers. We pooled data (n = 68; 55M, 13F) from two within-subject randomized controlled trials of healthy, ≥weekly cannabis users comparing the subjective and reinforcing effects of smoked active (~25 mg THC) versus placebo cannabis (0-mg THC). Subjective ratings of drug effects and mood were measured using visual analogue scales, and reinforcing effects were measured with a cannabis self-administration task. Sex-dependent outcomes were explored using generalized linear mixed models. Under active cannabis conditions, female participants reported greater reductions from baseline in cannabis craving and significantly higher cannabis-specific ratings of strength, liking, willingness to take again and good effect, compared with males (interaction p < 0.05). Placebo and active cannabis were self-administered by 22% and 36% of male participants, respectively, and by 15% and 54% of female participants, respectively. Receipt of active cannabis significantly increased likelihood of self-administration (p = 0.011), but a sex difference was not detected (p = 0.176). Although females were more sensitive to certain positive subjective effects of active cannabis, they were not more likely than males to self-administer it. These findings highlight the need to test sex differences as a primary objective in experimental studies and may shed light on accelerated trajectories from initiation to cannabis use disorder observed among women.
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Affiliation(s)
- Stephanie Lake
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza, Suite 38-418, Los Angeles, CA, 90095
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095
| | - Margaret Haney
- Department of Psychiatry, Division on Substance Use Disorders, Columbia University Irving Medical Center, New York State Psychiatric Institute, 1051 Riverside Drive, Unit 120, New York, NY, 10032
| | - Ziva D. Cooper
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, 760 Westwood Plaza, Suite 38-418, Los Angeles, CA, 90095
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, 757 Westwood Plaza, Los Angeles, CA, 90095
- Department of Anesthesiology and Perioperative Medicine, University of California, Los Angeles, 757 Westwood Plaza, Suite 3325, Los Angeles, CA, 90095
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Lile JA, Alcorn JL, Hays LR, Kelly TH, Stoops WW, Wesley MJ, Westgate PM. Influence of pregabalin maintenance on cannabis effects and related behaviors in daily cannabis users. Exp Clin Psychopharmacol 2022; 30:560-574. [PMID: 33983765 PMCID: PMC8969895 DOI: 10.1037/pha0000464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
No medications are approved for cannabis use disorder (CUD), though a small clinical trial demonstrated that the voltage-dependent calcium channel (VDCC) ligand gabapentin reduced cannabis use in treatment seekers. VDCCs are modulated by cannabinoid (CB) ligands, and there are shared effects between CB agonists and VDCC ligands. This overlapping neuropharmacology and the initial clinical results supported the evaluation of pregabalin, a "next-generation" VDCC ligand, as a CUD medication. Two separate placebo-controlled, double-blind, counterbalanced, within-subjects human laboratory studies tested placebo and 300 (N = 2 females, 11 males; Experiment [EXP] 1) or 450 (N = 3 females, 11 males; EXP 2) mg/day pregabalin in cannabis users who were not seeking treatment or trying to reduce/quit their cannabis use. The protocol consisted of two outpatient maintenance phases (11 days in EXP 1 and 15 days in EXP 2) that concluded with four experimental sessions within each phase. During experimental sessions, maintenance continued, and participants completed two 2-day blocks of sampling and self-administration sessions to determine the reinforcing effects of smoked cannabis (0% and 5.9% delta⁹-tetrahydrocannabinol [THC]), as well as subjective, attentional bias, performance, and physiological responses. In addition, naturalistic cannabis use, side effects, sleep quality, craving, and other self-reported substance use were measured during pregabalin maintenance. Cannabis was self-administered and produced prototypical effects, but pregabalin generally did not impact the effects of cannabis or alter naturalistic use. These human laboratory results in cannabis users not trying to reduce/quit their use do not support the efficacy of pregabalin as a stand-alone pharmacotherapy for CUD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Joshua A. Lile
- Department of Behavioral Science, University of Kentucky College of Medicine, College of Medicine Office Building, Lexington, KY 40536-0086, USA
- Department of Psychology, University of Kentucky College of Arts and Sciences, 106-B Kastle Hall, Lexington, KY 40506-0044, USA
- Department of Psychiatry, University of Kentucky College of Medicine, 3470 Blazer Pkwy, Lexington, KY 40509-1810, USA
| | - Joseph L. Alcorn
- Department of Behavioral Science, University of Kentucky College of Medicine, College of Medicine Office Building, Lexington, KY 40536-0086, USA
| | - Lon R. Hays
- Department of Psychiatry, University of Kentucky College of Medicine, 3470 Blazer Pkwy, Lexington, KY 40509-1810, USA
- Department of Internal Medicine, University of Kentucky College of Medicine, 740 South Limestone St., J525 Kentucky Clinic, Lexington, KY 40536-0284, USA
| | - Thomas H. Kelly
- Department of Behavioral Science, University of Kentucky College of Medicine, College of Medicine Office Building, Lexington, KY 40536-0086, USA
- Department of Psychology, University of Kentucky College of Arts and Sciences, 106-B Kastle Hall, Lexington, KY 40506-0044, USA
- Department of Psychiatry, University of Kentucky College of Medicine, 3470 Blazer Pkwy, Lexington, KY 40509-1810, USA
| | - William W. Stoops
- Department of Behavioral Science, University of Kentucky College of Medicine, College of Medicine Office Building, Lexington, KY 40536-0086, USA
- Department of Psychology, University of Kentucky College of Arts and Sciences, 106-B Kastle Hall, Lexington, KY 40506-0044, USA
- Department of Psychiatry, University of Kentucky College of Medicine, 3470 Blazer Pkwy, Lexington, KY 40509-1810, USA
| | - Michael J. Wesley
- Department of Behavioral Science, University of Kentucky College of Medicine, College of Medicine Office Building, Lexington, KY 40536-0086, USA
- Department of Psychology, University of Kentucky College of Arts and Sciences, 106-B Kastle Hall, Lexington, KY 40506-0044, USA
- Department of Psychiatry, University of Kentucky College of Medicine, 3470 Blazer Pkwy, Lexington, KY 40509-1810, USA
| | - Philip M. Westgate
- Department of Biostatistics, University of Kentucky College of Public Health, 111 Washington Ave, Lexington, KY 40536-0003, USA
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Tijani AO, Garg J, Frempong D, Verana G, Kaur J, Joga R, Sabanis CD, Kumar S, Kumar N, Puri A. Sustained drug delivery strategies for treatment of common substance use disorders: Promises and challenges. J Control Release 2022; 348:970-1003. [PMID: 35752256 DOI: 10.1016/j.jconrel.2022.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/16/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
Abstract
Substance use disorders (SUDs) are a leading cause of death and other ill health effects in the United States and other countries in the world. Several approaches ranging from detoxification, behavioral therapy, and the use of antagonists or drugs with counter effects are currently being applied for its management. Amongst these, drug therapy is the mainstay for some drug abuse incidences, as is in place specifically for opioid abuse or alcohol dependence. The severity of the havocs observed with the SUDs has triggered constant interest in the discovery and development of novel medications as well as suitable or most appropriate methods for the delivery of these agents. The chronic need of such drugs in users warrants the need for their prolonged or sustained systemic availability. Further, the need to improve patient tolerance to medication, limit invasive drug use and overall treatment outcome are pertinent considerations for embracing sustained release designs for medications used in managing SUDs. This review aims to provide an overview on up-to-date advances made with regards to sustained delivery systems for the drugs for treatment of different types of SUDs such as opioid, alcohol, tobacco, cocaine, and cannabis use disorders. The clinical relevance, promises and the limitations of deployed sustained release approaches along with future opportunities are discussed.
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Affiliation(s)
- Akeemat O Tijani
- Department of Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USA.
| | - Jivesh Garg
- University Institute of Pharmaceutical Sciences (UIPS), Panjab University, Chandigarh 160014, India
| | - Dorcas Frempong
- Department of Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USA.
| | - Gabrielle Verana
- Department of Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USA.
| | - Jagroop Kaur
- Department of Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USA.
| | - Ramesh Joga
- Department of Regulatory Affairs, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad 500 037, Telangana, India.
| | - Chetan D Sabanis
- Department of Regulatory Affairs, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad 500 037, Telangana, India.
| | - Sandeep Kumar
- Department of Regulatory Affairs, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad 500 037, Telangana, India.
| | - Neeraj Kumar
- Department of Regulatory Affairs, National Institute of Pharmaceutical Education and Research (NIPER), Hyderabad 500 037, Telangana, India.
| | - Ashana Puri
- Department of Pharmaceutical Sciences, Bill Gatton College of Pharmacy, East Tennessee State University, Johnson City, TN 37614, USA.
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Little R, D'Mello D. A Cannabinoid Hypothesis of Schizophrenia: Pathways to Psychosis. INNOVATIONS IN CLINICAL NEUROSCIENCE 2022; 19:38-43. [PMID: 36204167 PMCID: PMC9507146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Observations regarding psychostimulant and psychedelic drug-induced psychotic states led to the dopamine, serotonin, and glutamate hypotheses of schizophrenia. Expanding knowledge about the endocannabinoid system and the impact of exogenous cannabinoids on the brain and behavior have elucidated several putative pathways to cannabis-induced psychosis. OBJECTIVE The purpose of the present article was to describe these pathways and propose a cannabinoid hypothesis of schizophrenia. MAIN POINTS The endocannabinoid system was reviewed. Evidence regarding the effect of delta 9-tetrahydrocannabinol (THC) on the brain was described. A connection between cannabis use and first-episode psychosis was elucidated. CONCLUSION Understanding the putative pathways to cannabis-induced psychosis might lead to targeted therapeutic interventions and prevention of schizophrenia in susceptible individuals.
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Affiliation(s)
| | - Dale D'Mello
- Dr. D'Mello is Associate Professor Emeritus with the Department of Psychiatry at Michigan State University in East Lansing, Michigan
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Haney M, Bedi G, Cooper ZD, Herrmann ES, Reed SC, Foltin RW, Kingsley PJ, Marnett LJ, Patel S. Impact of cyclooxygenase‐2 inhibition on cannabis withdrawal and circulating endocannabinoids in daily cannabis smokers. Addict Biol 2022; 27:e13183. [DOI: 10.1111/adb.13183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/07/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Margaret Haney
- New York State Psychiatric Institute New York New York USA
- Columbia University Irving Medical Center New York New York USA
| | - Gillinder Bedi
- Centre for Youth Mental Health The University of Melbourne and Substance Use Research Group, Orygen Melbourne Australia
| | - Ziva D. Cooper
- Los Angeles Cannabis Research Initiative, Jane & Terry Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry and Biobehavioral Sciences, Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine University of California Los Angeles California USA
| | - Evan S. Herrmann
- Division of Therapeutics and Medical Consequences National Institute on Drug Abuse Bethesda Maryland USA
| | - Stephanie Collins Reed
- New York State Psychiatric Institute New York New York USA
- Columbia University Irving Medical Center New York New York USA
| | - Richard W. Foltin
- New York State Psychiatric Institute New York New York USA
- Columbia University Irving Medical Center New York New York USA
| | - Philip J. Kingsley
- A.B. Hancock Jr. Memorial Laboratory for Cancer Research, Departments of Biochemistry, Chemistry, and Pharmacology Vanderbilt University Nashville Tennessee USA
| | - Lawrence J. Marnett
- A.B. Hancock Jr. Memorial Laboratory for Cancer Research, Departments of Biochemistry, Chemistry, and Pharmacology Vanderbilt University Nashville Tennessee USA
| | - Sachin Patel
- Department of Psychiatry and Behavioral Sciences Vanderbilt University Medical Center Nashville Tennessee USA
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Manini AF, Krotulski AJ, Schimmel J, Allen L, Hurd YL, Richardson LD, Vidal K, Logan BK. Respiratory failure in confirmed synthetic cannabinoid overdose. Clin Toxicol (Phila) 2022; 60:524-526. [PMID: 34499005 PMCID: PMC9875316 DOI: 10.1080/15563650.2021.1975734] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
CONTEXT Synthetic cannabinoids (SCs) are a structurally heterogenous synthetic class of drugs of abuse. The objective was to describe the incidence of acute respiratory failure in Emergency Department (ED) patients with confirmed SC exposure, and to investigate the association between SC overdose with respiratory failure compared to non-SC overdose. METHODS This was an observational cohort of ED patients ≥18 years with suspected cannabinoid overdose between 2015 and 2020 at two tertiary-care hospitals. Patient serum was analyzed via liquid chromatography/quadrupole time-of-flight mass spectrometry using a library with >800 drugs including novel psychoactive substances. The primary outcome was acute respiratory failure. DISCUSSION Of 83 patients with suspected cannabinoid overdose, there were 29 confirmed SC overdoses: 5 F-MDMB-PICA (n = 18) and its metabolite 5OH-MDMB-PICA (n = 16), ADB-FUBINACA (n = 4), AB-CHIMINACA (n = 4), AB-FUBINACA (n = 1), AB-PINACA (n = 1), MDMB-4en-PINACA (n = 1), and 4 F-MDMB-BINACA (n = 1). Overall, incidence of acute respiratory failure was 31.3% (95%CI 21.6-42.4). Compared to non-SC overdose, confirmed SC overdose was significantly associated with respiratory failure (25.0% SC vs. 4.2% non-SC, p = 0.05). CONCLUSION This study demonstrates that SCs are associated with respiratory failure. Since respiratory depression is a potentially lethal adverse effect of SC overdose, future research is warranted.
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Affiliation(s)
- Alex F. Manini
- Division of Medical Toxicology, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Alex J. Krotulski
- Center for Forensic Science Research & Education, Fredric Rieders Family Foundation, Willow Grove, PA, USA
| | - Jonathan Schimmel
- Division of Medical Toxicology, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lisa Allen
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yasmin L. Hurd
- Departments of Psychiatry, Neuroscience, and Pharmacological Sciences; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lynne D. Richardson
- Departments of Emergency Medicine and Population Health Science & Policy, and Institute for Health Equity Research, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Kavey Vidal
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Barry K. Logan
- Center for Forensic Science Research & Education, Fredric Rieders Family Foundation, Willow Grove, PA, USA,NMS Labs, Horsham, PA, USA
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Bourgault Z, Matheson J, Mann RE, Brands B, Wickens CM, Tiwari AK, Zai CC, Kennedy J, Le Foll B. Mu opioid receptor gene variant modulates subjective response to smoked cannabis. Am J Transl Res 2022; 14:623-632. [PMID: 35173880 PMCID: PMC8829626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
The mu-opioid receptor (MOR) mediates the rewarding properties of many psychoactive drugs and is an important target in the treatment of addictions. Functional interactions between the opioid and endocannabinoid systems are established and have been hypothesized to contribute to the effects of cannabis. We investigated associations between three single nucleotide polymorphisms in the MOR gene OPRM1 (rs1799971, rs2281617, and rs510769) and subjective responses to smoked cannabis. Fifty-two regular cannabis users (1-4 days/week) were given a cannabis cigarette (12.5% THC) and rated their subjective responses on visual analog scales at baseline and at multiple time points after smoking. Blood samples were collected for THC quantification. There was a significant impact of the intronic variant rs510769 on subjective cannabis effects and THC blood levels. The influence of this gene variant may thus be mediated by pharmacodynamics and/or pharmacokinetic factors. We provide novel evidence that variability in OPRM1 contributes to individual responses to cannabis and may affect risk of cannabis use disorder. Our findings add to the growing body of literature on the genetic basis of individual responses to cannabis and may have implications for targeting the endogenous opioid system in the treatment of cannabis use disorder.
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Affiliation(s)
- Zoe Bourgault
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto33 Ursula Franklin Street, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of TorontoToronto, ON, Canada
| | - Justin Matheson
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto33 Ursula Franklin Street, Toronto, ON, Canada
| | - Robert E Mann
- Institute for Mental Health Policy Research, Centre for Addiction and Mental HealthToronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental HealthToronto, Ontario, Canada
- Dalla Lana School of Public Health, University of TorontoToronto, Ontario, Canada
| | - Bruna Brands
- Department of Pharmacology and Toxicology, University of TorontoToronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental HealthToronto, Canada
- Controlled Substances and Cannabis Directorate, Health CanadaOttawa, Canada
| | - Christine M Wickens
- Department of Pharmacology and Toxicology, University of TorontoToronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental HealthToronto, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental HealthToronto, Ontario, Canada
- Dalla Lana School of Public Health, University of TorontoToronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of TorontoToronto, Ontario, Canada
| | - Arun K Tiwari
- Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research InstituteCAMH, Toronto, ON, Canada
- Department of Psychiatry, University of TorontoToronto, ON, Canada
| | - Clement C Zai
- Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research InstituteCAMH, Toronto, ON, Canada
- Department of Psychiatry, University of TorontoToronto, ON, Canada
- Institute of Medical Science, University of TorontoToronto, ON, Canada
- Laboratory Medicine and Pathobiology, University of TorontoON, Canada
- T.H. Chan School of Public Health, Harvard UniversityBoston, MA, USA
- Broad InstituteCambridge, MA, USA
| | - James Kennedy
- Neurogenetics Section, Tanenbaum Centre for Pharmacogenetics, Molecular Brain Science, Campbell Family Mental Health Research InstituteCAMH, Toronto, ON, Canada
- Department of Psychiatry, University of TorontoToronto, ON, Canada
- Institute of Medical Science, University of TorontoToronto, ON, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Centre for Addiction and Mental Health, University of Toronto33 Ursula Franklin Street, Toronto, ON, Canada
- Department of Pharmacology and Toxicology, University of TorontoToronto, ON, Canada
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental HealthToronto, Ontario, Canada
- Department of Psychiatry, University of TorontoToronto, ON, Canada
- Institute of Medical Science, University of TorontoToronto, ON, Canada
- Acute Care Program, Centre for Addiction and Mental HealthToronto, ON, Canada
- Department of Family and Community Medicine, University of TorontoToronto, ON, Canada
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10
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Arout CA, Cooper ZD, Reed SC, Foltin RW, Comer SD, Levin FR, Haney M. 5HT-2C agonist lorcaserin decreases cannabis self-administration in daily cannabis smokers. Addict Biol 2021; 26:e12993. [PMID: 33389797 DOI: 10.1111/adb.12993] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/27/2020] [Accepted: 11/10/2020] [Indexed: 12/22/2022]
Abstract
There are no FDA-approved treatments for cannabis use disorder (CUD). Preclinical research has shown that the 5HT-2C agonist lorcaserin attenuates cue-induced reinstatement of THC seeking and self-administration. The goal of this placebo-controlled, counterbalanced, within-subject human laboratory study was to examine lorcaserin's effects on cannabis intoxication and self-administration. Lorcaserin (10 mg BID) was administered during one of two 13-day inpatient phases and placebo during the other; each phase was separated by ≥7 days of washout. Inpatient phases comprised (1) standardized cannabis administration (7.0% THC) at no financial cost (intoxication), counterbalanced with (2) the option to self-administer cannabis following either 0 or 3 days of abstinence. Cognitive task performance, food intake, subjective ratings of drug effects, objective/subjective sleep measures, and tobacco cigarette use were also assessed. Fifteen normal-weight, daily cannabis users (4F, 11M) not seeking treatment for CUD completed the study. Lorcaserin significantly reduced cannabis self-administration following 0 and 3 days of cannabis abstinence and also reduced craving for cannabis during abstinence. Lorcaserin produced small but significant increases in positive cannabis ratings and body weight relative to placebo. Lorcaserin also reduced tobacco cigarette smoking on days of cannabis administration relative to placebo. During abstinence, subjective but not objective measures of sleep quality worsened during lorcaserin maintenance. Overall, lorcaserin's ability to decrease drug taking and cannabis craving in nontreatment-seeking cannabis users supports further investigation of 5HT-2C agonists as potential pharmacotherapies for CUD.
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Affiliation(s)
- Caroline A. Arout
- Department of Psychiatry, New York State Psychiatric Institute Columbia University Irving Medical Center New York NY USA
| | - Ziva D. Cooper
- UCLA Cannabis Research Initiative, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences University of California, Los Angeles Los Angeles CA USA
| | - Stephanie Collins Reed
- Department of Psychiatry, New York State Psychiatric Institute Columbia University Irving Medical Center New York NY USA
| | - Richard W. Foltin
- Department of Psychiatry, New York State Psychiatric Institute Columbia University Irving Medical Center New York NY USA
| | - Sandra D. Comer
- Department of Psychiatry, New York State Psychiatric Institute Columbia University Irving Medical Center New York NY USA
| | - Frances R. Levin
- Department of Psychiatry, New York State Psychiatric Institute Columbia University Irving Medical Center New York NY USA
| | - Margaret Haney
- Department of Psychiatry, New York State Psychiatric Institute Columbia University Irving Medical Center New York NY USA
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11
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Abstract
Cannabis use disorder (CUD) is an underappreciated risk of using cannabis that affects ~10% of the 193 million cannabis users worldwide. The individual and public health burdens are less than those of other forms of drug use, but CUD accounts for a substantial proportion of persons seeking treatment for drug use disorders owing to the high global prevalence of cannabis use. Cognitive behavioural therapy, motivational enhancement therapy and contingency management can substantially reduce cannabis use and cannabis-related problems, but enduring abstinence is not a common outcome. No pharmacotherapies have been approved for cannabis use or CUD, although a number of drug classes (such as cannabinoid agonists) have shown promise and require more rigorous evaluation. Treatment of cannabis use and CUD is often complicated by comorbid mental health and other substance use disorders. The legalization of non-medical cannabis use in some high-income countries may increase the prevalence of CUD by making more potent cannabis products more readily available at a lower price. States that legalize medical and non-medical cannabis use should inform users about the risks of CUD and provide information on how to obtain assistance if they develop cannabis-related mental and/or physical health problems.
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12
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Winters KC, Mader J, Budney AJ, Stanger C, Knapp AA, Walker DD. Interventions for cannabis use disorder. Curr Opin Psychol 2020; 38:67-74. [PMID: 33338844 DOI: 10.1016/j.copsyc.2020.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/05/2020] [Accepted: 11/10/2020] [Indexed: 10/23/2022]
Abstract
How to treat adults and adolescents with a Cannabis Use Disorder is a burgeoning research area. This article reviews the empirical literature pertaining to several psychosocial approaches (cognitive-behavior therapy, motivational enhancement, and contingency management), all of which are associated with favorable outcomes. We also review the emerging research on the use of pharmacotherapy, brief interventions and technology-delivered interventions, and conclude with an overview of future research needs.
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13
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Dharmapuri S, Miller K, Klein JD. Marijuana and the Pediatric Population. Pediatrics 2020; 146:peds.2019-2629. [PMID: 32661188 DOI: 10.1542/peds.2019-2629] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2020] [Indexed: 11/24/2022] Open
Abstract
Cannabinoids, the psychoactive compounds in marijuana, are one of the most commonly used substances in the United States. In this review, we summarize the impact of marijuana on child and adolescent health and discuss the implications of marijuana use for pediatric practice. We review the changing epidemiology of cannabis use and provide an update on medical use, routes of administration, synthetic marijuana and other novel products, the effect of cannabis on the developing brain, other health and social consequences of use, and issues related to marijuana legalization.
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Affiliation(s)
- Sadhana Dharmapuri
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois.,Department of Pediatrics, Cook County Health and Hospitals System, Chicago, Illinois; and
| | - Kathleen Miller
- Adolescent Medicine Fellowship Program, Division of General Pediatrics and Adolescent Health, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Jonathan D Klein
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois;
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14
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Kebir O, Laqueille X, Mouaffak F. Mu-opioid antagonism in the treatment of cannabis use disorder. J Psychiatry Neurosci 2020; 45:143. [PMID: 32096619 PMCID: PMC7828912 DOI: 10.1503/jpn.190182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Oussama Kebir
- From the Service d’Addictologie Moreau de Tours, Centre hospitalier Sainte Anne, GHU Paris Psychiatrie & Neurosciences, Paris, France (Kebir, Laqueille); the Laboratoire physiopathologie des maladies psychiatriques, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Paris, France (Kebir); and the Unité de Psychiatrie de Liaison, d’Urgence et de Recherche, Pôle 93G04, EPS Ville Evrard, Saint Denis, France (Mouaffak)
| | - Xavier Laqueille
- From the Service d’Addictologie Moreau de Tours, Centre hospitalier Sainte Anne, GHU Paris Psychiatrie & Neurosciences, Paris, France (Kebir, Laqueille); the Laboratoire physiopathologie des maladies psychiatriques, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Paris, France (Kebir); and the Unité de Psychiatrie de Liaison, d’Urgence et de Recherche, Pôle 93G04, EPS Ville Evrard, Saint Denis, France (Mouaffak)
| | - Fayçal Mouaffak
- From the Service d’Addictologie Moreau de Tours, Centre hospitalier Sainte Anne, GHU Paris Psychiatrie & Neurosciences, Paris, France (Kebir, Laqueille); the Laboratoire physiopathologie des maladies psychiatriques, Institut de Psychiatrie et Neurosciences de Paris, INSERM U1266, Paris, France (Kebir); and the Unité de Psychiatrie de Liaison, d’Urgence et de Recherche, Pôle 93G04, EPS Ville Evrard, Saint Denis, France (Mouaffak)
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15
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Haney M, Cooper ZD, Bedi G, Herrmann E, Comer SD, Reed SC, Foltin RW, Levin FR. Guanfacine decreases symptoms of cannabis withdrawal in daily cannabis smokers. Addict Biol 2019; 24:707-716. [PMID: 29659126 DOI: 10.1111/adb.12621] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 12/22/2017] [Accepted: 02/12/2018] [Indexed: 01/27/2023]
Abstract
The α2a-adrenergic agonist, lofexidine, reduced cannabis withdrawal-related sleep disruption in the laboratory, but side effects (e.g. fatigue, hypotension) limit its utility as a treatment for cannabis use disorder. This study tested the potential efficacy and tolerability of a daily bedtime administration of the FDA-approved α2a-adrenergic agonist, guanfacine, in a human laboratory model of cannabis use disorder. Daily, nontreatment-seeking cannabis smokers (13M, 2F) completed a within-subject study comprising two 9-day inpatient study phases. Each phase tested the effects of daily placebo or immediate-release guanfacine (2 mg) on cannabis intoxication (5.6 percent THC; 2 days), withdrawal (4 days of abstinence) and subsequent 'relapse' (3 days of cannabis self-administration). Ratings of mood, sleep, cardiovascular effects, food intake, psychomotor performance and cannabis self-administration were assessed. An outpatient phase preceded each inpatient phase for medication clearance or dose induction. Under placebo medication conditions, cannabis abstinence produced significant withdrawal, including irritability, sleep disruption and anorexia. Guanfacine reduced ratings of irritability and improved objective measures of sleep during cannabis withdrawal relative to placebo but did not reduce cannabis self-administration. Guanfacine was well tolerated with little evidence of fatigue and only small decreases in blood pressure: no dose was held due to hypotension. Thus, a single daily administration of guanfacine at bedtime improved sleep and mood during cannabis withdrawal relative to placebo. This positive signal supports further studies varying the guanfacine dose, formulation or frequency of administration, or combining it with other medications to increase the likelihood of having an impact on cannabis use.
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Affiliation(s)
- Margaret Haney
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of PsychiatryColumbia University Medical Center New York NY USA
| | - Ziva D. Cooper
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of PsychiatryColumbia University Medical Center New York NY USA
| | - Gillinder Bedi
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of PsychiatryColumbia University Medical Center New York NY USA
| | - Evan Herrmann
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of PsychiatryColumbia University Medical Center New York NY USA
| | - Sandra D. Comer
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of PsychiatryColumbia University Medical Center New York NY USA
| | - Stephanie Collins Reed
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of PsychiatryColumbia University Medical Center New York NY USA
| | - Richard W. Foltin
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of PsychiatryColumbia University Medical Center New York NY USA
| | - Frances R. Levin
- Division on Substance Use Disorders, New York State Psychiatric Institute and Department of PsychiatryColumbia University Medical Center New York NY USA
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16
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Katner SN, Bredhold KE, Steagall KB, Bell RL, Neal-Beliveau BS, Cheong MC, Engleman EA. Caenorhabditis elegans as a model system to identify therapeutics for alcohol use disorders. Behav Brain Res 2019; 365:7-16. [PMID: 30802531 DOI: 10.1016/j.bbr.2019.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/15/2019] [Accepted: 02/10/2019] [Indexed: 02/04/2023]
Abstract
Alcohol use disorders (AUDs) cause serious problems in society and few effective treatments are available. Caenorhabditis elegans (C. elegans) is an excellent invertebrate model to study the neurobiological basis of human behavior with a conserved, fully tractable genome, and a short generation time for fast generation of data at a fraction of the cost of other organisms. C. elegans demonstrate movement toward, and concentration-dependent self-exposure to various psychoactive drugs. The discovery of opioid receptors in C. elegans provided the impetus to test the hypothesis that C. elegans may be used as a medications screen to identify new AUD treatments. We tested the effects of naltrexone, an opioid antagonist and effective treatment for AUDs, on EtOH preference in C. elegans. Six-well agar test plates were prepared with EtOH placed in a target zone on one side and water in the opposite target zone of each well. Worms were treated with naltrexone before EtOH preference testing and then placed in the center of each well. Wild-type worms exhibited a concentration-dependent preference for 50, 70 and 95% EtOH. Naltrexone blocked acute EtOH preference, but had no effect on attraction to food or benzaldehyde in wild-type worms. Npr-17 opioid receptor knockout mutants did not display a preference for EtOH. In contrast, npr-17 opioid receptor rescue mutants exhibited significant EtOH preference behavior, which was attenuated by naltrexone. Chronic EtOH exposure induced treatment resistance and compulsive-like behavior. These data indicate that C. elegans can serve as a model system to identify compounds to treat AUDs.
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Affiliation(s)
- Simon N Katner
- Department of Psychiatry & Institute of Psychiatric Research, Indianapolis, IN, 46202, USA.
| | | | - Kevin B Steagall
- Department of Psychiatry & Institute of Psychiatric Research, Indianapolis, IN, 46202, USA
| | - Richard L Bell
- Department of Psychiatry & Institute of Psychiatric Research, Indianapolis, IN, 46202, USA
| | | | - Mi C Cheong
- Department of Pharmacology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, 75390, USA
| | - Eric A Engleman
- Department of Psychiatry & Institute of Psychiatric Research, Indianapolis, IN, 46202, USA
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17
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Sabioni P, Le Foll B. Psychosocial and Pharmacological Interventions for the Treatment of Cannabis Use Disorder. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2019; 17:163-168. [PMID: 32021586 DOI: 10.1176/appi.focus.17202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
(Reprinted with permission from Sabioni P and Le Foll B. Psychosocial and pharmacological interventions for the treatment of cannabis use disorder [version 1; referees: 3 approved]. F1000Research 2018, 7(F1000 Faculty Rev):173 (https://doi.org/10.12688/f1000research.11191.1)).
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18
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Abstract
BACKGROUND Globally, cannabis use is prevalent and widespread. There are currently no pharmacotherapies approved for treatment of cannabis use disorders.This is an update of a Cochrane Review first published in the Cochrane Library in Issue 12, 2014. OBJECTIVES To assess the effectiveness and safety of pharmacotherapies as compared with each other, placebo or no pharmacotherapy (supportive care) for reducing symptoms of cannabis withdrawal and promoting cessation or reduction of cannabis use. SEARCH METHODS We updated our searches of the following databases to March 2018: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO and Web of Science. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs involving the use of medications to treat cannabis withdrawal or to promote cessation or reduction of cannabis use, or both, in comparison with other medications, placebo or no medication (supportive care) in people diagnosed as cannabis dependent or who were likely to be dependent. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS We included 21 RCTs involving 1755 participants: 18 studies recruited adults (mean age 22 to 41 years); three studies targeted young people (mean age 20 years). Most (75%) participants were male. The studies were at low risk of performance, detection and selective outcome reporting bias. One study was at risk of selection bias, and three studies were at risk of attrition bias.All studies involved comparison of active medication and placebo. The medications were diverse, as were the outcomes reported, which limited the extent of analysis.Abstinence at end of treatment was no more likely with Δ9-tetrahydrocannabinol (THC) preparations than with placebo (risk ratio (RR) 0.98, 95% confidence interval (CI) 0.64 to 1.52; 305 participants; 3 studies; moderate-quality evidence). For selective serotonin reuptake inhibitor (SSRI) antidepressants, mixed action antidepressants, anticonvulsants and mood stabilisers, buspirone and N-acetylcysteine, there was no difference in the likelihood of abstinence at end of treatment compared to placebo (low- to very low-quality evidence).There was qualitative evidence of reduced intensity of withdrawal symptoms with THC preparations compared to placebo. For other pharmacotherapies, this outcome was either not examined, or no significant differences was reported.Adverse effects were no more likely with THC preparations (RR 1.02, 95% CI 0.89 to 1.17; 318 participants; 3 studies) or N-acetylcysteine (RR 0.94, 95% CI 0.71 to 1.23; 418 participants; 2 studies) compared to placebo (moderate-quality evidence). For SSRI antidepressants, mixed action antidepressants, buspirone and N-acetylcysteine, there was no difference in adverse effects compared to placebo (low- to very low-quality evidence).There was no difference in the likelihood of withdrawal from treatment due to adverse effects with THC preparations, SSRIs antidepressants, mixed action antidepressants, anticonvulsants and mood stabilisers, buspirone and N-acetylcysteine compared to placebo (low- to very low-quality evidence).There was no difference in the likelihood of treatment completion with THC preparations, SSRI antidepressants, mixed action antidepressants and buspirone compared to placebo (low- to very low-quality evidence) or with N-acetylcysteine compared to placebo (RR 1.06, 95% CI 0.93 to 1.21; 418 participants; 2 studies; moderate-quality evidence). Anticonvulsants and mood stabilisers appeared to reduce the likelihood of treatment completion (RR 0.66, 95% CI 0.47 to 0.92; 141 participants; 3 studies; low-quality evidence).Available evidence on gabapentin (anticonvulsant), oxytocin (neuropeptide) and atomoxetine was insufficient for estimates of effectiveness. AUTHORS' CONCLUSIONS There is incomplete evidence for all of the pharmacotherapies investigated, and for many outcomes the quality of the evidence was low or very low. Findings indicate that SSRI antidepressants, mixed action antidepressants, bupropion, buspirone and atomoxetine are probably of little value in the treatment of cannabis dependence. Given the limited evidence of efficacy, THC preparations should be considered still experimental, with some positive effects on withdrawal symptoms and craving. The evidence base for the anticonvulsant gabapentin, oxytocin, and N-acetylcysteine is weak, but these medications are also worth further investigation.
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Affiliation(s)
- Suzanne Nielsen
- Monash UniversityMonash Addiction Research CentrePeninsula CampusMcMahons RoadFrankstonVICAustralia3199
| | - Linda Gowing
- University of AdelaideDiscipline of PharmacologyFrome RoadAdelaideSouth AustraliaAustralia5005
| | - Pamela Sabioni
- Centre for Addiction and Mental Health; University of TorontoTranslational Addiction Research Laboratory33 Russell StreetTorontoONCanada
| | - Bernard Le Foll
- Centre for Addiction and Mental Health; University of TorontoTranslational Addiction Research Laboratory33 Russell StreetTorontoONCanada
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19
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Nia AB, Mann C, Kaur H, Ranganathan M. Cannabis Use: Neurobiological, Behavioral, and Sex/Gender Considerations. Curr Behav Neurosci Rep 2018; 5:271-280. [PMID: 31548918 PMCID: PMC6756752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE OF REVIEW To summarize the current literature on the effects of cannabinoids in humans and to discuss the existing literature on the sex- and gender-related differences in the effects of cannabinoids. RECENT FINDINGS Cannabis and its constituent cannabinoids are associated with risk of addiction, cognitive deficits and mood/psychotic disorders. Preclinical and emerging clinical data suggest greater sensitivity to the effects of cannabinoids in women. SUMMARY Cannabis is one of the most commonly used drugs with increasing rates of use. Women in particular may be at a greater risk of adverse outcomes given the previously described "telescoping effect" of substance use in women. Human data examining the sex- and gender-related differences in the effects of cannabinoids and factors underlying these differences are very limited. This represents a critical gap in the literature and needs to be systematically examined in future studies.
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Affiliation(s)
| | - Claire Mann
- Icahn School of Medicine at Mount Sinai, New York City, New York
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20
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Bassir Nia A, Mann C, Kaur H, Ranganathan M. Cannabis Use: Neurobiological, Behavioral, and Sex/Gender Considerations. Curr Behav Neurosci Rep 2018. [DOI: 10.1007/s40473-018-0167-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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21
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Stuyt E. The Problem with the Current High Potency THC Marijuana from the Perspective of an Addiction Psychiatrist. MISSOURI MEDICINE 2018; 115:482-486. [PMID: 30643324 PMCID: PMC6312155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Elizabeth Stuyt
- Elizabeth 'Libby' Stuyt, MD, is a board certified Addiction Psychiatrist and a Senior Instructor for the University of Colorado Health Science Program, Department of Psychiatry. She is the medical director for a 90-inpatient dual diagnosis treatment program in Pueblo, Colorado
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22
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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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23
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Engleman EA, Steagall KB, Bredhold KE, Breach M, Kline HL, Bell RL, Katner SN, Neal-Beliveau BS. Caenorhabditis elegans Show Preference for Stimulants and Potential as a Model Organism for Medications Screening. Front Physiol 2018; 9:1200. [PMID: 30214414 PMCID: PMC6125605 DOI: 10.3389/fphys.2018.01200] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 08/10/2018] [Indexed: 12/20/2022] Open
Abstract
The nematode Caenorhabditis elegans (C. elegans) is a popular invertebrate model organism to study neurobiological disease states. This is due in part to the intricate mapping of all neurons and synapses of the entire animal, the wide availability of mutant strains, and the genetic and molecular tools that can be used to manipulate the genome and gene expression. We have shown that, C. elegans develops a conditioned preference for cues that had previously been paired with either cocaine or methamphetamine exposure that is dependent on dopamine neurotransmission, similar to findings using place conditioning with rats and mice. In the current study, we show C. elegans also display a preference for, and self-exposure to, cocaine and nicotine. This substance of abuse (SOA) preference response can be selectively blocked by pretreatment with naltrexone and is consistent with the recent discovery of an opioid receptor system in C. elegans. In addition, pre-exposure to the smoking cessation treatment varenicline also inhibits self-exposure to nicotine. Exposure to concentrations of treatments that inhibit SOA preference/self-exposure did not induce any significant inhibition of locomotor activity or affect food or benzaldehyde chemotaxis. These data provide predictive validity for the development of high-throughput C. elegans behavioral medication screens. These screens could enable fast and accurate generation of data to identify compounds that may be effective in treating human addiction. The successful development and validation of such models would introduce powerful and novel tools in the search for new pharmacological treatments for substance use disorders, and provide a platform to study the mechanisms that underlie addictions.
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Affiliation(s)
- Eric A Engleman
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Kevin B Steagall
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Kristin E Bredhold
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Michaela Breach
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Hannah L Kline
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Richard L Bell
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Simon N Katner
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Bethany S Neal-Beliveau
- Department of Psychology, School of Science, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
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24
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Kaye AD, Cornett EM, Patil SS, Gennuso SA, Colontonio MM, Latimer DR, Kaye AJ, Urman RD, Vadivelu N. New opioid receptor modulators and agonists. Best Pract Res Clin Anaesthesiol 2018; 32:125-136. [PMID: 30322454 DOI: 10.1016/j.bpa.2018.06.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 06/18/2018] [Indexed: 01/01/2023]
Abstract
There has been significant research to develop an ideal synthetic opioid. Opioids with variable properties possessing efficacy and with reduced side effects have been synthesized when compared to previously used agents. An opioid modulator is a drug that can produce both agonistic and antagonistic effects by binding to different opioid receptors and therefore cannot be classified as one or the other alone. These compounds can differ in their structures while still possessing opioid-mediated actions. This review will discuss TRV130 receptor modulators and other novel opioid receptor modulators, including Mitragyna "Kratom," Ignavine, Salvinorin-A, DPI-289, UFP-505, LP1, SKF-10,047, Cebranopadol, Naltrexone-14-O-sulfate, and Naloxegol. In summary, the structural elucidation of opioid receptors, allosteric modulation of opioid receptors, new opioid modulators and agonists, the employment of optogenetics, optopharmacology, and next-generation sequencing of opioid receptor genes and related functionality should create exciting new avenues for research and therapeutic development to treat conditions including pain, opioid abuse, and addiction.
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Affiliation(s)
- Alan D Kaye
- Department of Anesthesiology, LSU Health Sciences Center, Room 656, 1542 Tulane Ave., New Orleans, LA, 70112, USA.
| | - Elyse M Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Shilpa S Patil
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Sonja A Gennuso
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Matthew M Colontonio
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Dustin R Latimer
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA.
| | - Aaron J Kaye
- Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA.
| | - Nalini Vadivelu
- Department of Anesthesiology, Yale School of Medicine, 333 Cedar Street, TMP 3, PO Box 208051, New Haven, CT, 06520, USA.
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Mitchell MR, Berridge KC, Mahler SV. Endocannabinoid-Enhanced "Liking" in Nucleus Accumbens Shell Hedonic Hotspot Requires Endogenous Opioid Signals. Cannabis Cannabinoid Res 2018; 3:166-170. [PMID: 30069500 PMCID: PMC6069591 DOI: 10.1089/can.2018.0021] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Introduction: Stimulating either endogenous cannabinoids or opioids within a restricted dorsomedial “hedonic hotspot” in nucleus accumbens (NAc) shell enhances hedonic impact, or “liking” reactions to sweet tastes. In this study, we probed within this hotspot the relationship between endocannabinoid and opioid signals in hedonic enhancement. Materials and Methods: Specifically, we asked whether enhancement of sucrose “liking” by intra-NAc microinjections of the endocannabinoid anandamide requires concurrent endogenous opioid signaling. Results: Co-administration of the opioid antagonist naloxone in the same NAc microinjections with anandamide prevented the endocannabinoid from enhancing orofacial “liking” reactions to sucrose. Since intra-NAc hotspot naloxone injection alone failed to affect hedonics, reversal of anandamide-induced “liking” by opioid blockade reveals an interdependence of opioid and cannabinoid signaling in enhancing taste hedonic impact. Conclusions: These results elaborate our understanding of the mechanisms of hedonic processing of food rewards, and may also carry implications more generally for how opioid and cannabinoid drugs interact to generate natural pleasures, or drug-induced euphoria.
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Affiliation(s)
- Marci R Mitchell
- Department of Psychology, The University of Michigan, Ann Arbor, Michigan
| | - Kent C Berridge
- Department of Psychology, The University of Michigan, Ann Arbor, Michigan
| | - Stephen V Mahler
- Department of Neurobiology and Behavior, The University of California, Irvine, Irvine, California
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Herrmann ES, Jarvis BP, Sparks AC, Cohn AM, Koszowski B, Rosenberry ZR, Coleman-Cowger VH, Pickworth WB, Peters EN. Sweet flowers are slow, and weeds make haste: leveraging methodology from research on tobacco, alcohol, and opioid analgesics to make rapid and policy-relevant advances in cannabis science. Int Rev Psychiatry 2018; 30:238-250. [PMID: 30179535 PMCID: PMC6396691 DOI: 10.1080/09540261.2018.1465400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The legalization of medical and recreational cannabis use has occurred ahead of science. The current evidence base has poor utility for determining if cannabis products can meet the standards of safety, efficacy, and quality intrinsic to modern medicine, and for informing regulation of cannabis as a legal intoxicant. Individual jurisdictions that pass cannabis reforms may not have adequate resources to support the level of new scientific research needed to inform regulatory actions; this could make it difficult to keep a rapidly growing multi-billion-dollar cannabis industry in check. Further, the present lack of evidence-based regulatory oversight for cannabis parallels the climates that gave rise to the tobacco and prescription opioid epidemics, suggesting that continued omission may result in negative public health consequences. However, translating a methodological framework developed through research on these compounds may promote rapid advances in cannabis science germane to regulatory knowledge gaps. The present review highlights specific advancements in these areas, as well as in alcohol regulation, that are prime for informing policy-relevant cannabis science, and also offers some recommendations for evidence-based regulatory policy. Resulting progress may directly inform both regulation of cannabis in both medical and licit recreational drug frameworks, and new cannabis-related public health initiatives.
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Affiliation(s)
| | | | | | - Amy M. Cohn
- Individual and Population Health, Battelle, Baltimore, MD, USA
| | | | | | | | | | - Erica N. Peters
- Individual and Population Health, Battelle, Baltimore, MD, USA
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Wesley MJ, Westgate PM, Stoops WW, Kelly TH, Hays LR, Lile JA. Influence of tiagabine maintenance on cannabis effects and related behaviors in daily cannabis users. Exp Clin Psychopharmacol 2018; 26:310-319. [PMID: 29863387 PMCID: PMC5990026 DOI: 10.1037/pha0000180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
No medications are approved for cannabis use disorder (CUD). Gamma-aminobutyric acid (GABA) reuptake is modulated by cannabinoid (CB) receptor agonists, and there are shared effects between CB agonists and the GABA reuptake inhibitor tiagabine. This overlapping neuropharmacology suggested that tiagabine might be useful for CUD. The study determined the ability of tiagabine maintenance to reduce cannabis self-administration using a placebo-controlled, double-blind, counterbalanced, within-subjects design. Nontreatment-seeking daily cannabis users (N = 12; 3 female, 9 male) completed two 12-day outpatient maintenance phases (0 or 12 mg of tiagabine/day). Each phase consisted of a safety session, 7 maintenance days, and 4 experimental sessions. During experimental sessions, maintenance continued and participants completed two 2-day blocks of sampling and self-administration sessions to determine the reinforcing effects of smoked cannabis (0% and 5.9% Δ9-tetrahydrocannabinol). Naturalistic cannabis use, the subjective, performance and physiological response to cannabis, as well as side effects, sleep quality, craving, other self-reported substance use, and observer ratings were also measured. Cannabis functioned as a reinforcer and produced prototypical effects (e.g., increased heart rate and ratings of "high"), but tiagabine generally did not impact the effects of cannabis, or alter naturalistic use. Furthermore, tiagabine produced small, but significant, increases on 2 subscales of a Marijuana Craving Questionnaire, and reductions in both the amount of time slept in the past 24 hr and ratings of positive mood upon awakening. These human laboratory results from a sample of nontreatment-seeking cannabis users do not support the potential efficacy of 12 mg of tiagabine as a stand-alone pharmacotherapy for CUD. (PsycINFO Database Record
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Affiliation(s)
- Michael J. Wesley
- Department of Behavioral Science, University of Kentucky College of Medicine, College of Medicine Office Building, Lexington, KY 40536-0086, USA
| | - Philip M. Westgate
- Department of Biostatistics, University of Kentucky College of Public Health, 111 Washington Ave, Lexington, KY 40536, USA
| | - William W. Stoops
- Department of Behavioral Science, University of Kentucky College of Medicine, College of Medicine Office Building, Lexington, KY 40536-0086, USA,Department of Psychology, University of Kentucky College of Arts and Sciences, 106-B Kastle Hall, Lexington, KY 40506-0044, USA,Department of Psychiatry, University of Kentucky College of Medicine, 3470 Blazer Pkwy, Lexington, KY 40509-1810, USA
| | - Thomas H. Kelly
- Department of Behavioral Science, University of Kentucky College of Medicine, College of Medicine Office Building, Lexington, KY 40536-0086, USA,Department of Psychology, University of Kentucky College of Arts and Sciences, 106-B Kastle Hall, Lexington, KY 40506-0044, USA,Department of Psychiatry, University of Kentucky College of Medicine, 3470 Blazer Pkwy, Lexington, KY 40509-1810, USA
| | - Lon R. Hays
- Department of Psychiatry, University of Kentucky College of Medicine, 3470 Blazer Pkwy, Lexington, KY 40509-1810, USA,Department of Internal Medicine, University of Kentucky College of Medicine, 740 South Limestone St., J525 Kentucky Clinic, Lexington, KY 40536-0284, USA
| | - Joshua A. Lile
- Department of Behavioral Science, University of Kentucky College of Medicine, College of Medicine Office Building, Lexington, KY 40536-0086, USA,Department of Psychology, University of Kentucky College of Arts and Sciences, 106-B Kastle Hall, Lexington, KY 40506-0044, USA,Department of Psychiatry, University of Kentucky College of Medicine, 3470 Blazer Pkwy, Lexington, KY 40509-1810, USA,To whom correspondence should be addressed: Department of Behavioral Science, College of Medicine, University of Kentucky, Lexington, KY 40536-0086 phone: 1-859-323-6034 or fax: 1-859-323-5350
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28
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Sabioni P, Le Foll B. Psychosocial and pharmacological interventions for the treatment of cannabis use disorder. F1000Res 2018; 7:173. [PMID: 29497498 PMCID: PMC5811668 DOI: 10.12688/f1000research.11191.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2018] [Indexed: 11/24/2022] Open
Abstract
Cannabis use has been continuously increasing, and cannabis use disorder (CUD) has become a public health issue. Some psychosocial interventions have demonstrated the ability to reduce cannabis use; however, there are no pharmacotherapies approved for the treatment of CUD. Some drugs have shown limited positive effects on use and withdrawal symptoms, but no controlled studies have been able to show strong and persistent effects on clinically meaningful outcomes. The aim of this review is to synthesize the evidence from the available literature regarding the effectiveness of psychosocial and pharmacological treatments for CUD among adults (that is, 18 years old or older). An analysis of the evidence shows that the current best psychosocial intervention to reduce cannabis use is the combination of motivational enhancement therapy and cognitive-behavioral therapy, preferably accompanied by a contingency management approach. In regard to pharmacological interventions, there are mostly unclear findings. Some drugs, such as CB1 agonists, gabapentin, and N-acetylcysteine, have been shown to produce improvements in some symptoms of CUD in single studies, but these have not been replicated. Other classes of medications, including antidepressants and antipsychotics, have been unsuccessful in producing such effects. There is an imminent need for more clinical trials to develop more effective treatments for CUD.
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Affiliation(s)
- Pamela Sabioni
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , Toronto, Ontario , M5S 2S1, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health , Toronto, Ontario , M5S 2S1, Canada.,Addiction Medicine Service, Centre for Addiction and Mental Health, Toronto, Ontario, M6J 1H4, Canada.,Department of Family and Community Medicine, Pharmacology and Toxicology, Psychiatry, Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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29
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Notzon DP, Kelly MA, Choi CJ, Pavlicova M, Mahony AL, Brooks DJ, Mariani JJ, Levin FR. Open-label pilot study of injectable naltrexone for cannabis dependence. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2018; 44:619-627. [PMID: 29420073 DOI: 10.1080/00952990.2017.1423321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND There are no FDA-approved pharmacotherapies for cannabis use disorders (CUD), despite the evaluation of numerous medications. Notably, chronic dosing of oral naltrexone decreases self-administration of cannabis in human laboratory studies. OBJECTIVES To test the feasibility of long-acting injectable naltrexone for the treatment of CUD, while obtaining preliminary safety and efficacy data. METHODS Twelve adult participants (seven male) meeting DSM-IV-TR criteria for cannabis dependence enrolled into an 8-week, open-label pilot study conducted at an academic treatment research clinic. They received 380 mg intramuscular injections of long-acting naltrexone on study day 1 and at the start of study week 5. Outcome measures included percentages of study completers and participants who received the second injection, frequency of adverse events (AEs), and cannabis consumption measured by average daily grams, dollars, and using days per week as measured by timeline follow-back and urine oral delta-9-tetrahydrocannabinol (THC) concentrations. RESULTS Of the 12 participants enrolled in the study, 9 completed the study and 6 received the second injection. There were no severe AEs but an unexpected AE led to the addition of supportive medications to the protocol. Number of cannabis use days per week significantly decreased over the course of the study (p = .001). Creatinine-corrected urine THC concentrations and average daily cannabis use per study week in grams and in dollars did not decrease over the course of the study. CONCLUSIONS Long-acting injectable naltrexone is a feasible intervention for CUD worthy of further study in a placebo-controlled, double-blinded randomized clinical trial.
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Affiliation(s)
- Daniel P Notzon
- a Division on Substance Abuse , New York State Psychiatric Institute , New York , NY , USA.,b Department of Psychiatry , College of Physicians and Surgeons, Columbia University , New York , NY , USA
| | - Meredith A Kelly
- a Division on Substance Abuse , New York State Psychiatric Institute , New York , NY , USA.,b Department of Psychiatry , College of Physicians and Surgeons, Columbia University , New York , NY , USA
| | - C Jean Choi
- c Division of Biostatistics , New York State Psychiatric Institute , New York , NY , USA
| | - Martina Pavlicova
- d Department of Biostatistics , Mailman School of Public Health, Columbia University , New York , NY , USA
| | - Amy L Mahony
- a Division on Substance Abuse , New York State Psychiatric Institute , New York , NY , USA
| | - Daniel J Brooks
- a Division on Substance Abuse , New York State Psychiatric Institute , New York , NY , USA
| | - John J Mariani
- a Division on Substance Abuse , New York State Psychiatric Institute , New York , NY , USA.,b Department of Psychiatry , College of Physicians and Surgeons, Columbia University , New York , NY , USA
| | - Frances R Levin
- a Division on Substance Abuse , New York State Psychiatric Institute , New York , NY , USA.,b Department of Psychiatry , College of Physicians and Surgeons, Columbia University , New York , NY , USA
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30
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The Current State of Pharmacological Treatments for Cannabis Use Disorder and Withdrawal. Neuropsychopharmacology 2018; 43:173-194. [PMID: 28875989 PMCID: PMC5719115 DOI: 10.1038/npp.2017.212] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/31/2017] [Accepted: 08/31/2017] [Indexed: 02/07/2023]
Abstract
Cannabis use disorder (CUD) commonly occurs and carries a notable economic and functional burden at both individual and societal levels. While there are no clearly efficacious medication treatments for CUD, 20 years of committed and high-quality research in the human laboratory and clinical settings have resulted in medications with demonstrated effectiveness in the treatment of cannabis withdrawal, the ability to reduce cannabis use, and results that point to promising future work. The current state of pharmacology research for CUD highlights the need to consider particular characteristics of patients, such as gender, impulsivity, and severity of cannabis use, when selecting a medication in the off-label treatment of CUD or cannabis withdrawal. As a field, the body of work also exposes some areas in need of improvement in study design, selection of outcome measures, interpretation of results, and the overall process of evaluating candidate medications. Coming to a consensus as a field and addressing these gaps in future research will likely lend itself to further advances in improving the lives of patients with CUD.
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31
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Panlilio LV, Justinova Z. Preclinical Studies of Cannabinoid Reward, Treatments for Cannabis Use Disorder, and Addiction-Related Effects of Cannabinoid Exposure. Neuropsychopharmacology 2018; 43:116-141. [PMID: 28845848 PMCID: PMC5719102 DOI: 10.1038/npp.2017.193] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 08/17/2017] [Accepted: 08/22/2017] [Indexed: 12/21/2022]
Abstract
Cannabis use has become increasingly accepted socially and legally, for both recreational and medicinal purposes. Without reliable information about the effects of cannabis, people cannot make informed decisions regarding its use. Like alcohol and tobacco, cannabis can have serious adverse effects on health, and some people have difficulty discontinuing their use of the drug. Many cannabis users progress to using and becoming addicted to other drugs, but the reasons for this progression are unclear. The natural cannabinoid system of the brain is complex and involved in many functions, including brain development, reward, emotion, and cognition. Animal research provides an objective and controlled means of obtaining information about: (1) how cannabis affects the brain and behavior, (2) whether medications can be developed to treat cannabis use disorder, and (3) whether cannabis might produce lasting changes in the brain that increase the likelihood of becoming addicted to other drugs. This review explains the tactics used to address these issues, evaluates the progress that has been made, and offers some directions for future research.
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Affiliation(s)
- Leigh V Panlilio
- Preclinical Pharmacology Section, Behavioral Neuroscience Research Branch, Intramural Research Program, National Institute on Drug Abuse, NIH, DHHS, Baltimore, MD, USA
| | - Zuzana Justinova
- Preclinical Pharmacology Section, Behavioral Neuroscience Research Branch, Intramural Research Program, National Institute on Drug Abuse, NIH, DHHS, Baltimore, MD, USA
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32
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Richards JR, Schandera V, Elder JW. Treatment of acute cannabinoid overdose with naloxone infusion. TOXICOLOGY COMMUNICATIONS 2017. [DOI: 10.1080/24734306.2017.1392715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- John R. Richards
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA
| | - Verena Schandera
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA
| | - Joshua W. Elder
- Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA
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33
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Abstract
Purpose of the Review Cannabis is the most commonly used illicit substance worldwide. In recent decades, highly concentrated products have flooded the market, and prevalence rates have increased. Gender differences exist in cannabis use, as men have higher prevalence of both cannabis use and cannabis use disorder (CUD), while women progress more rapidly from first use to CUD. This paper reviews findings from preclinical and human studies examining the sex-specific neurobiological underpinnings of cannabis use and CUD, and associations with psychiatric symptoms. Recent Findings Sex differences exist in the endocannabinoid system, in cannabis exposure effects on brain structure and function, and in the co-occurrence of cannabis use with symptoms of anxiety, depression and schizophrenia. In female cannabis users, anxiety symptoms correlate with larger amygdala volume and social anxiety disorder symptoms correlate with CUD symptoms. Female cannabis users are reported to be especially vulnerable to earlier onset of schizophrenia, and mixed trends emerge in the correlation of depressive symptoms with cannabis exposure in females and males. Summary As prevalence of cannabis use may continue to increase given the shifting policy landscape regarding marijuana laws, understanding the neurobiological mechanisms of cannabis exposure in females and males is key. Examining these mechanisms may help inform future research on sex-specific pharmacological and behavioral interventions for women and men with high-risk cannabis use, comorbid psychiatric disease, and CUD.
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34
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Worley J. The Role of Pleasure Neurobiology and Dopamine in Mental Health Disorders. J Psychosoc Nurs Ment Health Serv 2017; 55:17-21. [PMID: 28850647 DOI: 10.3928/02793695-20170818-09] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Recent evidence and research has demonstrated that the pleasure response and associated neurotransmitters and brain circuits play a significant role in substance use disorders (SUDs). It was thought that negative behaviors associated with SUDs resulted from negative choices, but it is now known that chemical changes in the brain drive those behaviors. Several mental health disorders (e.g., eating disorders, non-suicidal self-injury, compulsive sex behaviors, internet gaming, gambling) are also thought to involve those same pleasure responses, neurotransmitters, and brain regions. Studies have shown that the use of naltrexone, a dopamine antagonist, can reduce symptoms of these disorders. It is important for nurses to understand the underlying physiology of mental health disorders that are thought to have an addictive or craving component. This understanding can help reduce stigma. Educating patients about likely neurobiological causes for their disorders can also help reduce guilt and shame. Nurses should educate patients about these disorders and evidence-based treatments, including off-label use of naltrexone. [Journal of Psychosocial Nursing and Mental Health Services, 55(9), 17-21.].
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35
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Soderstrom K, Soliman E, Van Dross R. Cannabinoids Modulate Neuronal Activity and Cancer by CB1 and CB2 Receptor-Independent Mechanisms. Front Pharmacol 2017; 8:720. [PMID: 29066974 PMCID: PMC5641363 DOI: 10.3389/fphar.2017.00720] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 09/25/2017] [Indexed: 12/29/2022] Open
Abstract
Cannabinoids include the active constituents of Cannabis or are molecules that mimic the structure and/or function of these Cannabis-derived molecules. Cannabinoids produce many of their cellular and organ system effects by interacting with the well-characterized CB1 and CB2 receptors. However, it has become clear that not all effects of cannabinoid drugs are attributable to their interaction with CB1 and CB2 receptors. Evidence now demonstrates that cannabinoid agents produce effects by modulating activity of the entire array of cellular macromolecules targeted by other drug classes, including: other receptor types; ion channels; transporters; enzymes, and protein- and non-protein cellular structures. This review summarizes evidence for these interactions in the CNS and in cancer, and is organized according to the cellular targets involved. The CNS represents a well-studied area and cancer is emerging in terms of understanding mechanisms by which cannabinoids modulate their activity. Considering the CNS and cancer together allow identification of non-cannabinoid receptor targets that are shared and divergent in both systems. This comparative approach allows the identified targets to be compared and contrasted, suggesting potential new areas of investigation. It also provides insight into the diverse sources of efficacy employed by this interesting class of drugs. Obtaining a comprehensive understanding of the diverse mechanisms of cannabinoid action may lead to the design and development of therapeutic agents with greater efficacy and specificity for their cellular targets.
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Affiliation(s)
- Ken Soderstrom
- Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Eman Soliman
- Department of Pharmacology and Toxicology, Zagazig University, Zagazig, Egypt
| | - Rukiyah Van Dross
- Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, United States
- Center for Health Disparities, East Carolina University, Greenville, NC, United States
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Abstract
The cannabis withdrawal syndrome (CWS) is a criterion of cannabis use disorders (CUDs) (Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition) and cannabis dependence (International Classification of Diseases [ICD]-10). Several lines of evidence from animal and human studies indicate that cessation from long-term and regular cannabis use precipitates a specific withdrawal syndrome with mainly mood and behavioral symptoms of light to moderate intensity, which can usually be treated in an outpatient setting. Regular cannabis intake is related to a desensitization and downregulation of human brain cannabinoid 1 (CB1) receptors. This starts to reverse within the first 2 days of abstinence and the receptors return to normal functioning within 4 weeks of abstinence, which could constitute a neurobiological time frame for the duration of CWS, not taking into account cellular and synaptic long-term neuroplasticity elicited by long-term cannabis use before cessation, for example, being possibly responsible for cannabis craving. The CWS severity is dependent on the amount of cannabis used pre-cessation, gender, and heritable and several environmental factors. Therefore, naturalistic severity of CWS highly varies. Women reported a stronger CWS than men including physical symptoms, such as nausea and stomach pain. Comorbidity with mental or somatic disorders, severe CUD, and low social functioning may require an inpatient treatment (preferably qualified detox) and post-acute rehabilitation. There are promising results with gabapentin and delta-9-tetrahydrocannabinol analogs in the treatment of CWS. Mirtazapine can be beneficial to treat CWS insomnia. According to small studies, venlafaxine can worsen the CWS, whereas other antidepressants, atomoxetine, lithium, buspirone, and divalproex had no relevant effect. Certainly, further research is required with respect to the impact of the CWS treatment setting on long-term CUD prognosis and with respect to psychopharmacological or behavioral approaches, such as aerobic exercise therapy or psychoeducation, in the treatment of CWS. The up-to-date ICD-11 Beta Draft is recommended to be expanded by physical CWS symptoms, the specification of CWS intensity and duration as well as gender effects.
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Affiliation(s)
- Udo Bonnet
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Evangelisches Krankenhaus Castrop-Rauxel, Academic Teaching Hospital of the University of Duisburg-Essen, Castrop-Rauxel
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, LVR-Hospital Essen, University of Duisburg-Essen, Essen
| | - Ulrich W Preuss
- Vitos-Klinik Psychiatrie und Psychotherapie Herborn, Herborn
- Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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37
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Jones JD, Nolan ML, Daver R, Comer SD, Paone D. Can Naloxone Be Used to Treat Synthetic Cannabinoid Overdose? Biol Psychiatry 2017; 81:e51-e52. [PMID: 27765269 PMCID: PMC5846114 DOI: 10.1016/j.biopsych.2016.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 08/08/2016] [Accepted: 08/08/2016] [Indexed: 10/21/2022]
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Abstract
This paper is the thirty-eighth consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2015 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior, and the roles of these opioid peptides and receptors in pain and analgesia, stress and social status, tolerance and dependence, learning and memory, eating and drinking, drug abuse and alcohol, sexual activity and hormones, pregnancy, development and endocrinology, mental illness and mood, seizures and neurologic disorders, electrical-related activity and neurophysiology, general activity and locomotion, gastrointestinal, renal and hepatic functions, cardiovascular responses, respiration and thermoregulation, and immunological responses.
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY 11367, United States.
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39
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Curran HV, Freeman TP, Mokrysz C, Lewis DA, Morgan CJA, Parsons LH. Keep off the grass? Cannabis, cognition and addiction. Nat Rev Neurosci 2016; 17:293-306. [PMID: 27052382 DOI: 10.1038/nrn.2016.28] [Citation(s) in RCA: 238] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In an increasing number of states and countries, cannabis now stands poised to join alcohol and tobacco as a legal drug. Quantifying the relative adverse and beneficial effects of cannabis and its constituent cannabinoids should therefore be prioritized. Whereas newspaper headlines have focused on links between cannabis and psychosis, less attention has been paid to the much more common problem of cannabis addiction. Certain cognitive changes have also been attributed to cannabis use, although their causality and longevity are fiercely debated. Identifying why some individuals are more vulnerable than others to the adverse effects of cannabis is now of paramount importance to public health. Here, we review the current state of knowledge about such vulnerability factors, the variations in types of cannabis, and the relationship between these and cognition and addiction.
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Affiliation(s)
- H Valerie Curran
- Clinical Psychopharmacology Unit, University College London, Gower Street, London WC1E 6BT, UK
| | - Tom P Freeman
- Clinical Psychopharmacology Unit, University College London, Gower Street, London WC1E 6BT, UK
| | - Claire Mokrysz
- Clinical Psychopharmacology Unit, University College London, Gower Street, London WC1E 6BT, UK
| | - David A Lewis
- Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, Pennsylvania 15213, USA
| | - Celia J A Morgan
- Clinical Psychopharmacology Unit, University College London, Gower Street, London WC1E 6BT, UK.,Psychopharmacology and Addiction Research Centre, University of Exeter, Perry Road, Exeter EX4 4QG, UK
| | - Loren H Parsons
- The Scripps Research Institute, 10550 N. Torrey Pines Road, SP30-2001, La Jolla, California 92037, USA
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40
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Panlilio LV, Justinova Z, Trigo JM, Le Foll B. Screening Medications for the Treatment of Cannabis Use Disorder. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2016; 126:87-120. [PMID: 27055612 DOI: 10.1016/bs.irn.2016.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Cannabis use has been increasingly accepted legally and in public opinion. However, cannabis has the potential to produce adverse physical and mental health effects, and cannabis use disorder (CUD) occurs in a substantial percentage of both occasional and daily cannabis users. Many people have difficulty discontinuing use despite receiving treatment. Therefore, it would be beneficial to develop safe and effective medications for treating CUD. To achieve this, methods have been developed for screening and evaluating potential medications using animal models and controlled experimental protocols in human volunteers. In this chapter, we describe: (1) animal models available for assessing the effect of potential medications on specific aspects of CUD, (2) the main findings obtained so far with these animal models, (3) the approaches used to assess potential medications in humans in laboratory experiments and clinical trials, and (4) the effectiveness of several potential pharmacotherapies on particular aspects of CUD modeled in these human studies.
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Affiliation(s)
- L V Panlilio
- Preclinical Pharmacology Section, Behavioral Neuroscience Research Branch, NIDA, NIH, DHHS, Baltimore, MD, United States
| | - Z Justinova
- Preclinical Pharmacology Section, Behavioral Neuroscience Research Branch, NIDA, NIH, DHHS, Baltimore, MD, United States
| | - J M Trigo
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada
| | - B Le Foll
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Addiction Medicine Service, Ambulatory Care and Structured Treatments, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
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Tek C. Naltrexone HCI/bupropion HCI for chronic weight management in obese adults: patient selection and perspectives. Patient Prefer Adherence 2016; 10:751-9. [PMID: 27217728 PMCID: PMC4862388 DOI: 10.2147/ppa.s84778] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Naltrexone, an opiate antagonist, and bupropion, a noradrenergic/dopaminergic antidepressant, have many effects on the reward systems of the brain. These medications impact eating behavior, presumably via their impact on food reward. However, only bupropion induces weight loss in obese individuals, while naltrexone does not have any appreciable effect. The combination of 32 mg of naltrexone and 360 mg of bupropion in a sustained-release combination pill form has been recently approved for obesity treatment. Studies have shown that the combination of these two medications is more effective in inducing weight loss, when combined with lifestyle intervention and calorie reduction, than each individual medicine alone. The naltrexone-bupropion combination, when combined with lifestyle intervention and modest calorie reduction, seems to be quite effective for 6-month and 1-year outcomes for clinically significant weight loss (over 5% of total body weight). These medications are not devoid of serious side effects, however, and careful patient selection can reduce dramatic complications and increase positive outcomes. This paper reviews existing weight loss clinical trials with bupropion and the bupropion-naltrexone combination. Additionally, the rationale for the suggested patient selection and clinical strategies for special patient populations are discussed.
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Affiliation(s)
- Cenk Tek
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Correspondence: Cenk Tek, Room 267c, Department of Psychiatry, Yale University School of Medicine, 34 Park Street, New Haven, CT 06519, USA, Email
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