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Lee YK, Gold MS, Blum K, Thanos PK, Hanna C, Fuehrlein BS. Opioid use disorder: current trends and potential treatments. Front Public Health 2024; 11:1274719. [PMID: 38332941 PMCID: PMC10850316 DOI: 10.3389/fpubh.2023.1274719] [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: 08/08/2023] [Accepted: 12/29/2023] [Indexed: 02/10/2024] Open
Abstract
Opioid use disorder (OUD) is a major public health threat, contributing to morbidity and mortality from addiction, overdose, and related medical conditions. Despite our increasing knowledge about the pathophysiology and existing medical treatments of OUD, it has remained a relapsing and remitting disorder for decades, with rising deaths from overdoses, rather than declining. The COVID-19 pandemic has accelerated the increase in overall substance use and interrupted access to treatment. If increased naloxone access, more buprenorphine prescribers, greater access to treatment, enhanced reimbursement, less stigma and various harm reduction strategies were effective for OUD, overdose deaths would not be at an all-time high. Different prevention and treatment approaches are needed to reverse the concerning trend in OUD. This article will review the recent trends and limitations on existing medications for OUD and briefly review novel approaches to treatment that have the potential to be more durable and effective than existing medications. The focus will be on promising interventional treatments, psychedelics, neuroimmune, neutraceutical, and electromagnetic therapies. At different phases of investigation and FDA approval, these novel approaches have the potential to not just reduce overdoses and deaths, but attenuate OUD, as well as address existing comorbid disorders.
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Affiliation(s)
- Yu Kyung Lee
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, United States
| | - Mark S. Gold
- Department of Psychiatry, Washington University in St. Louis Euclid Ave, St. Louis, MO, United States
| | - Kenneth Blum
- Division of Addiction Research and Education, Center for Sports, Exercise, and Mental Health, Western University Health Sciences, Pomona, CA, United States
| | - Panayotis K. Thanos
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, Clinical Research Institute on Addictions, State University of New York at Buffalo, Buffalo, NY, United States
| | - Colin Hanna
- Behavioral Neuropharmacology and Neuroimaging Laboratory on Addictions, Department of Pharmacology and Toxicology, Jacobs School of Medicine and Biosciences, Clinical Research Institute on Addictions, State University of New York at Buffalo, Buffalo, NY, United States
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Hornick MG, Stefanski A. Hallucinogenic potential: a review of psychoplastogens for the treatment of opioid use disorder. Front Pharmacol 2023; 14:1221719. [PMID: 37675046 PMCID: PMC10477608 DOI: 10.3389/fphar.2023.1221719] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 08/09/2023] [Indexed: 09/08/2023] Open
Abstract
The United States is entering its fourth decade of the opioid epidemic with no clear end in sight. At the center of the epidemic is an increase in opioid use disorder (OUD), a complex condition encompassing physical addiction, psychological comorbidities, and socioeconomic and legal travails associated with the misuse and abuse of opioids. Existing behavioral and medication-assisted therapies show limited efficacy as they are hampered by lack of access, strict regimens, and failure to fully address the non-pharmacological aspects of the disease. A growing body of research has indicated the potential of hallucinogens to efficaciously and expeditiously treat addictions, including OUD, by a novel combination of pharmacology, neuroplasticity, and psychological mechanisms. Nonetheless, research into these compounds has been hindered due to legal, social, and safety concerns. This review will examine the preclinical and clinical evidence that psychoplastogens, such as ibogaine, ketamine, and classic psychedelics, may offer a unique, holistic alternative for the treatment of OUD while acknowledging that further research is needed to establish long-term efficacy along with proper safety and ethical guidelines.
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Affiliation(s)
- Mary G. Hornick
- College of Science, Health and Pharmacy, Roosevelt University, Schaumburg, IL, United States
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The Bright Side of Psychedelics: Latest Advances and Challenges in Neuropharmacology. Int J Mol Sci 2023; 24:ijms24021329. [PMID: 36674849 PMCID: PMC9865175 DOI: 10.3390/ijms24021329] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 12/31/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
The need to identify effective therapies for the treatment of psychiatric disorders is a particularly important issue in modern societies. In addition, difficulties in finding new drugs have led pharmacologists to review and re-evaluate some past molecules, including psychedelics. For several years there has been growing interest among psychotherapists in psilocybin or lysergic acid diethylamide for the treatment of obsessive-compulsive disorder, of depression, or of post-traumatic stress disorder, although results are not always clear and definitive. In fact, the mechanisms of action of psychedelics are not yet fully understood and some molecular aspects have yet to be well defined. Thus, this review aims to summarize the ethnobotanical uses of the best-known psychedelic plants and the pharmacological mechanisms of the main active ingredients they contain. Furthermore, an up-to-date overview of structural and computational studies performed to evaluate the affinity and binding modes to biologically relevant receptors of ibogaine, mescaline, N,N-dimethyltryptamine, psilocin, and lysergic acid diethylamide is presented. Finally, the most recent clinical studies evaluating the efficacy of psychedelic molecules in some psychiatric disorders are discussed and compared with drugs already used in therapy.
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Mosca A, Chiappini S, Miuli A, Mancusi G, Santovito MC, Di Carlo F, Pettorruso M, Corkery JM, Canessa C, Martinotti G, Di Giannantonio M. Ibogaine/Noribogaine in the Treatment of Substance Use Disorders: A Systematic Review of the Current Literature. Curr Neuropharmacol 2023; 21:2178-2194. [PMID: 36263479 PMCID: PMC10556383 DOI: 10.2174/1570159x21666221017085612] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Ibogaine and noribogaine are psychedelic substances with dissociative properties naturally occurring in plants of the Apocynaceae family. Research has shown their efficacy in treating substance use disorders (SUD), particularly in opiate detoxification, but their efficacy and toxicity are still unclear. OBJECTIVE This review aims to assess the anti-addictive role of ibogaine and evaluate its side effects. METHODS A systematic literature review was conducted on the 29th of November 2021 using PubMed, Scopus and Web of Science databases through the following search strategy: ("Ibogaine" OR "Noribogaine") AND ("SUD" OR "substance use disorder" OR "craving" OR "abstinence" OR "withdrawal" OR "addiction" OR "detoxification") NOT animal NOT review NOT "vitro." The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was followed for data gathering purposes. Research methods were registered on PROSPERO (CRD42021287034). RESULTS Thirty-one articles were selected for the systematic revision, and two were considered for analysis. The results were organised according to the type of study: case reports/case series, randomised- controlled trials (RCTs), open-label, survey and observational studies. The main outcomes were related to the anti-addictive effect of ibogaine and its cardiac toxicity. A meta-analysis of side effects was conducted using RevMan 5.4 software, showing a significant risk of developing headaches after ibogaine/noribogaine treatment. CONCLUSION The results show some efficacy of ibogaine in the treatment of SUDs, but its cardiotoxicity and mortality are worrying. Further studies are needed to assess its therapeutic efficacy and actual safety.
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Affiliation(s)
- Alessio Mosca
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, 66100, Italy
| | - Stefania Chiappini
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, 66100, Italy
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, AL10 9AB, UK
| | - Andrea Miuli
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, 66100, Italy
| | - Gianluca Mancusi
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, 66100, Italy
| | - Maria Chiara Santovito
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, 66100, Italy
| | - Francesco Di Carlo
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, 66100, Italy
| | - Mauro Pettorruso
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, 66100, Italy
| | - John M. Corkery
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, AL10 9AB, UK
| | | | - Giovanni Martinotti
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, 66100, Italy
- Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, AL10 9AB, UK
| | - Massimo Di Giannantonio
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D’Annunzio, Chieti-Pescara, 66100, Italy
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Ona G, Rocha JM, Bouso JC, Hallak JEC, Borràs T, Colomina MT, Dos Santos RG. The adverse events of ibogaine in humans: an updated systematic review of the literature (2015-2020). Psychopharmacology (Berl) 2022; 239:1977-1987. [PMID: 34406452 DOI: 10.1007/s00213-021-05964-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 08/09/2021] [Indexed: 01/29/2023]
Abstract
CONTEXT Ibogaine is the main alkaloid of the African shrub Tabernanthe iboga. It produces hallucinogenic and psychostimulant effects, but it is currently known for the anti-addictive properties. Despite the potential therapeutic effects, several cases of fatalities and serious adverse events related to ibogaine/noribogaine use can be found in the literature. Most studies consist in case reports or were conducted under non-controlled settings, so causation cannot be clearly established. OBJECTIVES To update (2015-2020) the literature on the adverse events and fatalities associated with ibogaine/noribogaine administration. METHODS Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS Eighteen studies were included in the final selection. Highly heterogeneous results were found in terms of kind of product used or the known dosages. The adverse events were classified in acute effects (< 24 h), mainly cardiac (the most common was QTc prolongation), gastrointestinal, neurological, and clinical alterations, and long-lasting effects (> 24 h), mainly persistent cardiac alterations, psychiatric, and neurological signs. CONCLUSIONS There is a high need of phase I clinical trials that can describe the safety of different dosages of ibogaine with standardized products. Further research should perform clinical profiling of vulnerable populations, and design effective screening methods and clinical procedures.
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Affiliation(s)
- Genís Ona
- International Center for Ethnobotanical Education, Research, and Service (ICEERS), Barcelona, Spain
- Department of Psychology and Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Tarragona, Spain
- Medical Anthropology Research Center (MARC), Universitat Rovira i Virgili, Tarragona, Spain
| | - Juliana Mendes Rocha
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Hospital das Clínicas, Terceiro Andar, Av. Bandeirantes, Ribeirão Preto, SP, 3900, Brazil
| | - José Carlos Bouso
- International Center for Ethnobotanical Education, Research, and Service (ICEERS), Barcelona, Spain
- Medical Anthropology Research Center (MARC), Universitat Rovira i Virgili, Tarragona, Spain
| | - Jaime E C Hallak
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Hospital das Clínicas, Terceiro Andar, Av. Bandeirantes, Ribeirão Preto, SP, 3900, Brazil
- National Institute for Translational Medicine (INCT-TM), CNPq, Ribeirão Preto, Brazil
| | - Tre Borràs
- Hospital Universitari Sant Joan de Reus. Servei de Drogodependències I Salut Mental. Pla D'Accions Sobre Drogues de Reus, Reus, Spain
| | - Maria Teresa Colomina
- Department of Psychology and Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Tarragona, Spain
- Universitat Rovira i Virgili, Research in Neurobehavior and Health (NEUROLAB), Tarragona, Spain
| | - Rafael G Dos Santos
- International Center for Ethnobotanical Education, Research, and Service (ICEERS), Barcelona, Spain.
- Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Hospital das Clínicas, Terceiro Andar, Av. Bandeirantes, Ribeirão Preto, SP, 3900, Brazil.
- National Institute for Translational Medicine (INCT-TM), CNPq, Ribeirão Preto, Brazil.
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Lee YK, Gold MS, Fuehrlein BS. Looking beyond the opioid receptor: A desperate need for new treatments for opioid use disorder. J Neurol Sci 2022; 432:120094. [PMID: 34933249 DOI: 10.1016/j.jns.2021.120094] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 12/10/2021] [Accepted: 12/12/2021] [Indexed: 10/19/2022]
Abstract
The mainstay of treatment for opioid use disorder (OUD) is opioid agonist therapy (OAT), which modulates opioid receptors to reduce substance craving and use. OAT maintains dependence on opioids but helps reduce overdose and negative sequelae of substance abuse. Despite increasing availability of OAT, its effectiveness is limited by difficulty in initiating and maintaining patients on treatment. With the worsening opioid epidemic in the United States and rising overdose deaths, a more durable and effective treatment for OUD is necessary. This paper reviews novel treatments being investigated for OUD, including neuromodulatory interventions, psychedelic drugs, and other novel approaches. Neuromodulatory interventions can stimulate the addiction neural circuitry involving the dorsolateral prefrontal cortex and deeper mesolimbic structures to curb craving and reduce use, and multiple clinical trials for interventional treatment for OUD are currently conducted. Similarly, psychedelic agents are being investigated for efficacy in OUD specifically. There is a resurgence of interest in psychedelic agents' therapeutic potential, with evidence of improving mood symptoms and decreased substance use even after just one dose. Exact mechanism of their anti-addictive effect is not fully elucidated, but psychedelic agents do not maintain opioid dependence and some may even be helpful in abating symptoms of withdrawal. Other potential approaches for OUD include targeting different parts of the dopamine-dependent addiction pathway, identifying susceptible genes and modulating gene products, as well as utilizing vaccines as immunotherapy to blunt the addictive effects of substances. Much more clinical data are needed to support efficacy and safety of these therapies in OUD, but these proposed novel treatments look beyond the opioid receptor to offer hope for a more durably effective OUD treatment.
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Affiliation(s)
- Yu Kyung Lee
- School of Medicine, Yale University, 333 Cedar St, New Haven, CT 06510, USA.
| | - Mark S Gold
- Washington University School of Medicine, 660 S. Euclid Ave., St. Louis, MO 63110, USA.
| | - Brian S Fuehrlein
- Department of Psychiatry, Yale University, 300 George Street, New Haven, CT 06511, USA.
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