1
|
Fitzgerald ND, Liu Y, Wang A, Striley CW, Setlow B, Knackstedt L, Cottler LB. Sequencing hour-level temporal patterns of polysubstance use among persons who use cocaine, alcohol, and cannabis: A back-translational approach. Drug Alcohol Depend 2024; 258:111272. [PMID: 38555662 DOI: 10.1016/j.drugalcdep.2024.111272] [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] [Received: 12/11/2023] [Revised: 03/07/2024] [Accepted: 03/19/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Polysubstance use is highly prevalent among persons who use cocaine; however, little is known about how alcohol and cannabis are used with cocaine. We identified temporal patterns of cocaine+alcohol and cocaine+cannabis polysubstance use to inform more translationally relevant preclinical models. METHODS Participants who used cocaine plus alcohol and/or cannabis at least once in the past 30 days (n=148) were interviewed using the computerized Substance Abuse Module and the newer Polysubstance Use-Temporal Patterns Section. For each day in the past 30 days, participants reported whether they had used cocaine, alcohol, and cannabis; if any combinations of use were endorsed, participants described detailed hourly use of each substance on the most "typical day" for the combination. Sequence analysis and hierarchical clustering were applied to identify patterns of timing of drug intake on typical days of cocaine polysubstance use. RESULTS We identified five temporal patterns among the 180 sequences of reported cocaine polysubstance use: 1) limited cocaine/cocaine+alcohol use (53%); 2) extensive cannabis then cocaine+alcohol+cannabis use (22%); 3) limited alcohol/cannabis then cocaine+alcohol use (13%); 4) extensive cocaine+cannabis then cocaine+alcohol+cannabis use (4%); and 5) extensive cocaine then cocaine+alcohol use (8%). While drug intake patterns differed, prevalence of use disorders did not. CONCLUSIONS Patterns were characterized by cocaine, alcohol, and cannabis polysubstance use and by the timing, order, duration, and quantity of episode-level substance use. The identification of real-world patterns of cocaine polysubstance use represents an important step toward developing laboratory models that accurately reflect human behavior.
Collapse
Affiliation(s)
- Nicole D Fitzgerald
- Department of Epidemiology, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, FL, USA; Center for Addiction Research and Education, University of Florida, Gainesville, FL, USA.
| | - Yiyang Liu
- Department of Epidemiology, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, FL, USA; Center for Addiction Research and Education, University of Florida, Gainesville, FL, USA
| | - Anna Wang
- Department of Epidemiology, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, FL, USA; Center for Addiction Research and Education, University of Florida, Gainesville, FL, USA
| | - Catherine W Striley
- Department of Epidemiology, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, FL, USA; Center for Addiction Research and Education, University of Florida, Gainesville, FL, USA
| | - Barry Setlow
- Center for Addiction Research and Education, University of Florida, Gainesville, FL, USA; Department of Psychiatry, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Lori Knackstedt
- Center for Addiction Research and Education, University of Florida, Gainesville, FL, USA; Department of Psychology, College of Liberal Arts and Sciences, University of Florida, Gainesville, FL, USA
| | - Linda B Cottler
- Department of Epidemiology, Colleges of Medicine and Public Health & Health Professions, University of Florida, Gainesville, FL, USA; Center for Addiction Research and Education, University of Florida, Gainesville, FL, USA
| |
Collapse
|
2
|
Maddern XJ, Walker LC, Campbell EJ, Arunogiri S, Haber PS, Morley K, Manning V, Millan EZ, McNally GP, Lubman DI, Lawrence AJ. Can we enhance the clinical efficacy of cognitive and psychological approaches to treat substance use disorders through understanding their neurobiological mechanisms? Neurosci Biobehav Rev 2022; 142:104899. [PMID: 36183863 DOI: 10.1016/j.neubiorev.2022.104899] [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: 08/20/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/19/2022]
Abstract
Despite decades of research in the field of addiction, relapse rates for substance use disorders remain high. Consequently, there has been growing focus on providing evidence-based treatments for substance use disorders, resulting in the increased development and use of cognitive and psychological interventions. Such treatment approaches, including contingency management, community-reinforcement approach, and cognitive bias modification, have shown promising clinical efficacy in reducing substance use and promoting abstinence during treatment. However, these interventions are still somewhat limited in achieving sustained periods of abstinence post-treatment. The neurobiological mechanisms underpinning these treatment approaches remain largely unknown and under-studied, in part, due to a lack of translational animal models. The adoption of a reverse translational approach may assist in development of more representative models that can facilitate elucidation of the mechanisms behind these clinically relevant interventions. This review examines our current understanding of addiction neurobiology from clinical, preclinical research and existing animal models, and considers how the efficacy of such behavioral-oriented interventions alone, or in combination with pharmacotherapy, may be enhanced to improve treatment outcomes.
Collapse
Affiliation(s)
- Xavier J Maddern
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC 3010, Australia; Florey Department of Neuroscience and Mental Health, University of Melbourne, VIC 3010, Australia.
| | - Leigh C Walker
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC 3010, Australia; Florey Department of Neuroscience and Mental Health, University of Melbourne, VIC 3010, Australia
| | - Erin J Campbell
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC 3010, Australia; Florey Department of Neuroscience and Mental Health, University of Melbourne, VIC 3010, Australia; School of Biomedical Sciences and Pharmacy, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia; Brain Neuromodulation Research Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Shalini Arunogiri
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia
| | - Paul S Haber
- Edith Collins Centre, Drug Health Services, Sydney Local Health District, Camperdown, Australia; Sydney Medical School, University of Sydney, NSW, Australia
| | - Kirsten Morley
- Sydney Medical School, University of Sydney, NSW, Australia
| | - Victoria Manning
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia
| | | | | | - Dan I Lubman
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, Australia; Turning Point, Eastern Health, Melbourne, Australia
| | - Andrew J Lawrence
- Florey Institute of Neuroscience and Mental Health, Parkville, VIC 3010, Australia; Florey Department of Neuroscience and Mental Health, University of Melbourne, VIC 3010, Australia.
| |
Collapse
|
3
|
Charles SJ, Farias M, van Mulukom V, Saraswati A, Dein S, Watts F, Dunbar RIM. Blocking mu-opioid receptors inhibits social bonding in rituals. Biol Lett 2020; 16:20200485. [PMID: 33050833 PMCID: PMC7655482 DOI: 10.1098/rsbl.2020.0485] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Religious rituals are universal human practices that play a seminal role in community bonding. In two experiments, we tested the role of mu-opioids as the active factor fostering social bonding. We used a mu-opioid blocker (naltrexone) in two double-blind studies of rituals from different religious traditions. We found the same effect across both studies, with naltrexone leading to significantly lower social bonding compared with placebo. These studies suggest that mu-opioids play a significant role in experiences of social bonding within ritual contexts.
Collapse
Affiliation(s)
- S J Charles
- Brain, Belief, and Behaviour lab; Centre for Trust, Peace and Social Relations, Coventry University, Cheetah Road, Coventry CV1 2TL, UK
| | - M Farias
- Brain, Belief, and Behaviour lab; Centre for Trust, Peace and Social Relations, Coventry University, Cheetah Road, Coventry CV1 2TL, UK
| | - V van Mulukom
- Brain, Belief, and Behaviour lab; Centre for Trust, Peace and Social Relations, Coventry University, Cheetah Road, Coventry CV1 2TL, UK
| | - A Saraswati
- Traditional Yoga Association, Reading RG30 3DW, UK
| | - S Dein
- Department of Mental Health, Queen Mary University of London, London E1 4NS, UK
| | - F Watts
- International Society for Science and Religion, Cambridge, UK
| | - R I M Dunbar
- Department of Experimental Psychology, University of Oxford, UK
| |
Collapse
|
4
|
Santos RA, Rae M, Dartora VFMC, Matos JKR, Camarini R, Lopes LB. Bioresponsive nanostructured systems for sustained naltrexone release and treatment of alcohol use disorder: Development and biological evaluation. Int J Pharm 2020; 585:119474. [PMID: 32473371 DOI: 10.1016/j.ijpharm.2020.119474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 01/16/2023]
Abstract
In this study, microemulsions capable of transforming into nanostructured hexagonal phase gels in vivo upon uptake of biological fluids for naltrexone prolonged release were investigated as a strategy for management of alcohol use disorder (AUD). Microemulsions were prepared using monoolein, tricaprylin, water and propylene glycol; after preliminary characterization, one formulation was selected, which contained 55% of monoolein-tricaprylin (M-55). This microemulsion displayed size below 200 nm and Newtonian rheological behavior. Liquid crystalline gels formed in vitro upon 8 h of contact with water following a second order kinetics. After 120 h, <50% of naltrexone was released in vitro independently on drug loading (5 or 10%). In vivo, gels formed within 24 h of M-55 subcutaneous administration, and persisted locally for over 30 days providing slow release of the fluorescent marker Alexa fluor compared to a solution. Using the conditioned place preference paradigm, a test used to measure drug's rewarding effects, a single dose of M-55 containing 5% naltrexone reduced the time spent in the ethanol-paired compartment by 1.8-fold compared to saline; this effect was similar to that obtained with daily naltrexone injections, demonstrating the formulation efficacy and its ability to reduce dosing frequency. A more robust effect was observed following administration of M-55 containing 10% of naltrexone, which was compatible with aversion. These results support M-55 as a platform for sustained release of drugs that can be further explored for management of AUD to reduce dosing frequency and aid treatment adherence.
Collapse
Affiliation(s)
- Rogério A Santos
- Department of Pharmacology, Instituto de Ciências Biomédicas - Universidade de Sao Paulo, Brazil
| | - Mariana Rae
- Department of Pharmacology, Instituto de Ciências Biomédicas - Universidade de Sao Paulo, Brazil
| | - Vanessa F M C Dartora
- Department of Pharmacology, Instituto de Ciências Biomédicas - Universidade de Sao Paulo, Brazil
| | - Jenyffer K R Matos
- Department of Pharmacology, Instituto de Ciências Biomédicas - Universidade de Sao Paulo, Brazil
| | - Rosana Camarini
- Department of Pharmacology, Instituto de Ciências Biomédicas - Universidade de Sao Paulo, Brazil
| | - Luciana B Lopes
- Department of Pharmacology, Instituto de Ciências Biomédicas - Universidade de Sao Paulo, Brazil.
| |
Collapse
|
5
|
Chan B, Kondo K, Freeman M, Ayers C, Montgomery J, Kansagara D. Pharmacotherapy for Cocaine Use Disorder-a Systematic Review and Meta-analysis. J Gen Intern Med 2019; 34:2858-2873. [PMID: 31183685 PMCID: PMC6854210 DOI: 10.1007/s11606-019-05074-8] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 05/01/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Currently, there are no accepted FDA-approved pharmacotherapies for cocaine use disorder, though numerous medications have been tested in clinical trials. We conducted a systematic review and meta-analysis to better understand the effectiveness of pharmacotherapy for cocaine use disorder. METHODS We searched multiple data sources (MEDLINE, PsycINFO, and Cochrane Library) through November 2017 for systematic reviews and randomized controlled trials (RCTs) of pharmacological interventions in adults with cocaine use disorder. When possible, we combined the findings of trials with comparable interventions and outcome measures in random-effects meta-analyses. We assessed the risk of bias of individual trials and the strength of evidence for each outcome using standardized criteria. Outcomes included continuous abstinence (3+ consecutive weeks); cocaine use; harms; and study retention. For relapse prevention studies (participants abstinent at baseline), we examined lapse (first cocaine positive or missing UDS) and relapse (two consecutive cocaine positive or missed UDS'). RESULTS Sixty-six different drugs or drug combinations were studied in seven systematic reviews and 48 RCTs that met inclusion criteria. Antidepressants were the most widely studied drug class (38 RCTs) but appear to have no effect on cocaine use or treatment retention. Increased abstinence was found with bupropion (2 RCTs: RR 1.63, 95% CI 1.02 to 2.59), topiramate (2 RCTs: RR 2.56, 95% CI 1.39 to 4.73), and psychostimulants (14 RCTs: RR 1.36, 95% CI 1.05 to 1.77), though the strength of evidence for these findings was low. We found moderate strength of evidence that antipsychotics improved treatment retention (8 RCTs: RR 1.33, 95% CI 1.03 to 1.75). DISCUSSION Most of the pharmacotherapies studied were not effective for treating cocaine use disorder. Bupropion, psychostimulants, and topiramate may improve abstinence, and antipsychotics may improve retention. Contingency management and behavioral interventions along with pharmacotherapy should continue to be explored. SR REGISTRATION Prospero CRD42018085667.
Collapse
Affiliation(s)
- Brian Chan
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, 3181 SW Sam Jackson Park Road L475, Portland, OR, 97239-3098, USA.
- Central City Concern, Portland, OR, USA.
| | - Karli Kondo
- Evidence Synthesis Program Center, VA Portland Health Care System, Portland, OR, USA
- Research Integrity Office, Oregon Health & Science University, Portland, OR, USA
| | - Michele Freeman
- Evidence Synthesis Program Center, VA Portland Health Care System, Portland, OR, USA
| | - Chelsea Ayers
- Evidence Synthesis Program Center, VA Portland Health Care System, Portland, OR, USA
| | - Jessica Montgomery
- Evidence Synthesis Program Center, VA Portland Health Care System, Portland, OR, USA
| | - Devan Kansagara
- Division of General Internal Medicine and Geriatrics, Oregon Health & Science University, 3181 SW Sam Jackson Park Road L475, Portland, OR, 97239-3098, USA
- Evidence Synthesis Program Center, VA Portland Health Care System, Portland, OR, USA
- Department of Medicine, VA Portland Health Care System, Portland, OR, USA
| |
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW Cocaine is a highly addictive substance with serious medical and mental health consequences. Despite these concerns, there are no Food and Drug Administration-approved medications for the treatment of cocaine use disorder (CUD). Although many medication-assisted treatments (MATs) have been investigated, no clear guidelines exist for clinicians treating patients with CUDs. RECENT FINDINGS There are a limited number of recent data examining MATs for CUD. Multiple high-quality reviews of existing literature have been performed with psychostimulants, modafinil, bupropion, topiramate and disulfiram showing the most promise. Evidence is limited by heterogeneity of studies, small sample sizes and inconsistent results. SUMMARY The current literature does not strongly support any individual MAT for CUD. Psychosocial interventions, namely contingency management, have the most evidence for treatment of CUD, but it is worth seriously considering MAT for patients who do not respond well to psychosocial interventions alone given limitations in access to care, relatively low risks associated with MAT and significant morbidity associated with CUD. Further research into MAT for CUD is necessary, as the combination of MAT and psychosocial interventions may be better than either alone.
Collapse
|
7
|
Sikora M, Rakowska A, Olszewska M, Rudnicka L. The Use of Naltrexone in Dermatology. Current Evidence and Future Directions. Curr Drug Targets 2019; 20:1058-1067. [PMID: 30887922 DOI: 10.2174/1389450120666190318121122] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/04/2019] [Accepted: 03/10/2019] [Indexed: 01/29/2023]
Abstract
Naltrexone is a competitive opioid receptor antagonist approved as supportive treatment in alcohol dependence and opioid addiction. At a dose of 50-100 mg daily, naltrexone is used off-label in dermatology for the treatment of trichotillomania and different types of pruritus. At a dose as low as 1- 5 mg per day, naltrexone demonstrates immunomodulatory action i.e. modulates Toll-like receptors signaling, decreases release of proinflammatory cytokines (tumor necrosis factor, interleukin-6, interleukin- 12), inhibits T lymphocyte proliferation, down-regulates the expression of chemokine receptors and adhesion molecules. The efficacy of standard and low doses of naltrexone in a variety of dermatological disorders has been reported. These include diseases such as familial benign chronic pemphigus (Hailey-Hailey disease), dermatomyositis, systemic sclerosis, psoriasis and lichen planopilaris. Optimistic preliminary findings, low cost of therapy and good tolerance make naltrexone a promising alternative therapy or adjunct drug in dermatology.
Collapse
Affiliation(s)
- Mariusz Sikora
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland
| | - Adriana Rakowska
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland
| | - Małgorzata Olszewska
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland
| | - Lidia Rudnicka
- Department of Dermatology, Medical University of Warsaw, Koszykowa 82A, 02-008 Warsaw, Poland
| |
Collapse
|
8
|
Tardelli VS, Lago MPPD, Mendez M, Bisaga A, Fidalgo TM. Contingency Management with pharmacologic treatment for Stimulant Use Disorders: A review. Behav Res Ther 2018; 111:57-63. [DOI: 10.1016/j.brat.2018.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 09/30/2018] [Accepted: 10/03/2018] [Indexed: 11/29/2022]
|
9
|
Naltrexone and nalmefene attenuate cocaine place preference in male mice. Neuropharmacology 2018; 140:174-183. [DOI: 10.1016/j.neuropharm.2018.07.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/30/2018] [Accepted: 07/22/2018] [Indexed: 02/06/2023]
|
10
|
Kallupi M, Shen Q, de Guglielmo G, Yasuda D, Journigan VB, Zaveri NT, Ciccocioppo R. Buprenorphine requires concomitant activation of NOP and MOP receptors to reduce cocaine consumption. Addict Biol 2018. [PMID: 28635181 DOI: 10.1111/adb.12513] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Buprenorphine's clinical use is approved for the treatment of heroin addiction; however, evidence supporting its efficacy in cocaine abuse also exists. While for heroin it has been demonstrated that the effect of buprenorphine is mediated by its ability to activate μ-opioid peptide receptor (MOP) receptors, the mechanism through which it attenuates cocaine intake remains elusive. We explored this mechanism using operant models where rodents were trained to chronically self-administer cocaine for 2 hours daily. Buprenorphine (0.3, 1.0 and 3.0 mg/kg) given intraperitoneally 90 minutes before access to cocaine significantly and dose dependently reduced its intake. Pre-treatment with naltrexone or with the selective nociceptin/orphanin FQ peptide (NOP) antagonist SB-612111 did not prevent buprenorphine-induced reduction of cocaine intake. However, when naltrexone and SB-612111 were combined, the effect of buprenorphine on cocaine was completely prevented. To confirm that co-activation of MOP and NOP receptors is the underlying mechanism through which buprenorphine reduces cocaine intake, three compounds, namely, AT-034, AT-201 and AT-202, with a range of affinity and intrinsic activity profiles for MOP and NOP receptors, but weak ability for kappa-opioid peptide receptor (KOP) transmission, were tested. Consistent with our hypothesis based on buprenorphine's effects, results demonstrated that AT-034 and AT-201, which co-activate MOP and NOP receptors, reduced cocaine self-administration like buprenorphine. AT-202, which selectively stimulates NOP receptors, was not effective. Together, these data demonstrate that for buprenorphine, co-activation of MOP and NOP receptors is essential to reduce cocaine consumption. These results open new vistas on the treatment of cocaine addiction by developing compounds with mixed MOP/NOP agonist properties.
Collapse
Affiliation(s)
- Marsida Kallupi
- School of Pharmacy, Pharmacology Unit; University of Camerino; Italy
- Committee on the Neurobiology of Addictive Disorders; The Scripps Research Institute; La Jolla CA USA
| | - Qianwei Shen
- School of Pharmacy, Pharmacology Unit; University of Camerino; Italy
| | - Giordano de Guglielmo
- School of Pharmacy, Pharmacology Unit; University of Camerino; Italy
- Committee on the Neurobiology of Addictive Disorders; The Scripps Research Institute; La Jolla CA USA
| | | | | | | | | |
Collapse
|
11
|
Mongi-Bragato B, Avalos MP, Guzmán AS, Bollati FA, Cancela LM. Enkephalin as a Pivotal Player in Neuroadaptations Related to Psychostimulant Addiction. Front Psychiatry 2018; 9:222. [PMID: 29892236 PMCID: PMC5985699 DOI: 10.3389/fpsyt.2018.00222] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 05/08/2018] [Indexed: 12/21/2022] Open
Abstract
Enkephalin expression is high in mesocorticolimbic areas associated with psychostimulant-induced behavioral and neurobiological effects, and may also modulate local neurotransmission in this circuit network. Psychostimulant drugs, like amphetamine and cocaine, significantly increase the content of enkephalin in these brain structures, but we do not yet understand the specific significance of this drug-induced adaptation. In this review, we summarize the neurochemical and molecular mechanism of psychostimulant-induced enkephalin activation in mesocorticolimbic brain areas, and the contribution of this opioid peptide in the pivotal neuroadaptations and long-term behavioral changes underlying psychostimulant addiction. There is evidence suggesting that adaptive changes in enkephalin content in the mesocorticolimbic circuit, induced by acute and chronic psychostimulant administration, may represent a key initial step in the long-term behavioral and neuronal plasticity induced by these drugs.
Collapse
Affiliation(s)
- Bethania Mongi-Bragato
- Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET), Departamento de Farmacología, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - María P Avalos
- Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET), Departamento de Farmacología, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Andrea S Guzmán
- Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET), Departamento de Farmacología, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Flavia A Bollati
- Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET), Departamento de Farmacología, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Liliana M Cancela
- Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET), Departamento de Farmacología, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina
| |
Collapse
|
12
|
Moerke MJ, Banks ML, Cheng K, Rice KC, Negus SS. Maintenance on naltrexone+amphetamine decreases cocaine-vs.-food choice in male rhesus monkeys. Drug Alcohol Depend 2017; 181:85-93. [PMID: 29040826 PMCID: PMC5683900 DOI: 10.1016/j.drugalcdep.2017.09.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/01/2017] [Accepted: 09/20/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cocaine use disorder remains a significant public health issue for which there are no FDA-approved pharmacotherapies. Amphetamine maintenance reduces cocaine use in preclinical and clinical studies, but the mechanism of this effect is unknown. Previous studies indicate a role for endogenous opioid release and subsequent opioid receptor activation in some amphetamine effects; therefore, the current study examined the role of mu-opioid receptor activation in d-amphetamine treatment effects in an assay of cocaine-vs-food choice. METHODS Adult male rhesus monkeys with double-lumen intravenous catheters responded for concurrently available food pellets and cocaine injections (0-0.1mg/kg/injection) during daily sessions. Cocaine choice and overall reinforcement rates were evaluated during 7-day treatments with saline or test drugs. RESULTS During saline treatment, cocaine maintained a dose-dependent increase in cocaine-vs.-food choice. The mu-opioid receptor agonist morphine (0.032-0.32mg/kg/h) dose-dependently increased cocaine choice and decreased rates of reinforcement. A dose of the mu-selective opioid receptor antagonist naltrexone (0.0032mg/kg/h) that completely blocked morphine effects had no effect on cocaine choice when it was administered alone, but it enhanced the effectiveness of a threshold dose of 0.032mg/kg/h amphetamine to decrease cocaine choice without also enhancing nonselective behavioral disruption by this dose of amphetamine. Conversely, the kappa-selective opioid antagonist norbinalorphimine did not enhance amphetamine effects on cocaine choice. CONCLUSIONS These results suggest that amphetamine maintenance produces mu opioid-receptor mediated effects that oppose its anti-cocaine effects. Co-administration of naltrexone may selectively enhance amphetamine potency to decrease cocaine choice without increasing amphetamine potency to produce general behavioral disruption.
Collapse
Affiliation(s)
- Megan J Moerke
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 410 N. 12th St., Richmond, VA 23298, USA.
| | - Matthew L Banks
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 410 N. 12th St., Richmond, VA 23298, USA.
| | - Kejun Cheng
- Drug Design and Synthesis Section, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20852, USA; Office of Pharmaceutical Quality, The Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD 20993, USA.
| | - Kenner C Rice
- Drug Design and Synthesis Section, National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20852, USA.
| | - S Stevens Negus
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, 410 N. 12th St., Richmond, VA 23298, USA.
| |
Collapse
|
13
|
Naltrexone modulates dopamine release following chronic, but not acute amphetamine administration: a translational study. Transl Psychiatry 2017; 7:e1104. [PMID: 28440810 PMCID: PMC5416714 DOI: 10.1038/tp.2017.79] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 03/08/2017] [Indexed: 01/16/2023] Open
Abstract
The opioid antagonist naltrexone has been shown to attenuate the subjective effects of amphetamine. However, the mechanisms behind this modulatory effect are currently unknown. We hypothesized that naltrexone would diminish the striatal dopamine release induced by amphetamine, which is considered an important mechanism behind many of its stimulant properties. We used positron emission tomography and the dopamine D2-receptor radioligand [11C]raclopride in healthy subjects to study the dopaminergic effects of an amphetamine injection after pretreatment with naltrexone or placebo. In a rat model, we used microdialysis to study the modulatory effects of naltrexone on dopamine levels after acute and chronic amphetamine exposure. In healthy humans, naltrexone attenuated the subjective effects of amphetamine, confirming our previous results. Amphetamine produced a significant reduction in striatal radioligand binding, indicating increased levels of endogenous dopamine. However, there was no statistically significant effect of naltrexone on dopamine release. The same pattern was observed in rats, where an acute injection of amphetamine caused a significant rise in striatal dopamine levels, with no effect of naltrexone pretreatment. However, in a chronic model, naltrexone significantly attenuated the dopamine release caused by reinstatement of amphetamine. Collectively, these data suggest that the opioid system becomes engaged during the more chronic phase of drug use, evidenced by the modulatory effect of naltrexone on dopamine release following chronic amphetamine administration. The importance of opioid-dopamine interactions in the reinforcing and addictive effects of amphetamine is highlighted by the present findings and may help to facilitate medication development in the field of stimulant dependence.
Collapse
|
14
|
Safety and Tolerability of Pharmacological Treatment of Alcohol Dependence: Comprehensive Review of Evidence. Drug Saf 2016; 39:627-45. [DOI: 10.1007/s40264-016-0416-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
15
|
Mongi-Bragato B, Zamponi E, García-Keller C, Assis MA, Virgolini MB, Mascó DH, Zimmer A, Cancela LM. Enkephalin is essential for the molecular and behavioral expression of cocaine sensitization. Addict Biol 2016; 21:326-38. [PMID: 25431310 DOI: 10.1111/adb.12200] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Behavioral sensitization to cocaine is associated to neuroadaptations that contribute to addiction. Enkephalin is highly expressed in mesocorticolimbic areas associated with cocaine-induced sensitization; however, their influence on cocaine-dependent behavioral and neuronal plasticity has not been explained. In this study, we employed a knockout (KO) model to investigate the contribution of enkephalin in cocaine-induced behavioral sensitization. Wild-type (WT) and proenkephalin KO mice were treated with cocaine once daily for 9 days to induce sensitization. Additionally, to clarify the observations in KO mice, the same procedure was applied in C57BL/6 mice, except that naloxone was administered before each cocaine injection. All animals received a cocaine challenge on days 15 and 21 of the treatment to evaluate the expression of locomotor sensitization. On day 21, microdialysis measures of accumbal extracellular dopamine, Western blotting for GluR1 AMPA receptor (AMPAR), phosphorylated ERK2 (pERK2), CREB (pCREB), TrKB (pTrkB) were performed in brain areas relevant for sensitization from KO and WT and/or naloxone- and vehicle pre-treated animals. We found that KO mice do not develop sensitization to the stimulating properties of cocaine on locomotor activity and on dopamine release in the nucleus accumbens (NAc). Furthermore, pivotal neuroadaptations such as the increase in pTrkB receptor, pERK/CREB and AMPAR related to sensitized responses were absent in the NAc from KO mice. Consistently, full abrogation of cocaine-induced behavioral and neuronal plasticity after naloxone pre-treatment was observed. We show for first time that the proenkephalin system is essential in regulating long-lasting pivotal neuroadaptations in the NAc underlying behavioral sensitization to cocaine.
Collapse
Affiliation(s)
- Bethania Mongi-Bragato
- Departamento de Farmacología; Facultad de Ciencias Químicas; Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET); Universidad Nacional de Córdoba; Argentina
| | - Emiliano Zamponi
- Centro de Biología Celular y Molecular-Instituto de Investigaciones Biológicas y Tecnológicas (CEBICEM-IIByT); Facultad de Ciencias Exactas, Físicas y Naturales; Universidad Nacional de Córdoba; Argentina
| | - Constanza García-Keller
- Departamento de Farmacología; Facultad de Ciencias Químicas; Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET); Universidad Nacional de Córdoba; Argentina
| | - María Amparo Assis
- Departamento de Farmacología; Facultad de Ciencias Químicas; Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET); Universidad Nacional de Córdoba; Argentina
| | - Miriam B. Virgolini
- Departamento de Farmacología; Facultad de Ciencias Químicas; Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET); Universidad Nacional de Córdoba; Argentina
| | - Daniel H. Mascó
- Centro de Biología Celular y Molecular-Instituto de Investigaciones Biológicas y Tecnológicas (CEBICEM-IIByT); Facultad de Ciencias Exactas, Físicas y Naturales; Universidad Nacional de Córdoba; Argentina
| | - Andreas Zimmer
- Institute of Molecular Psychiatry; University of Bonn; Germany
| | - Liliana M. Cancela
- Departamento de Farmacología; Facultad de Ciencias Químicas; Instituto de Farmacología Experimental de Córdoba (IFEC-CONICET); Universidad Nacional de Córdoba; Argentina
| |
Collapse
|
16
|
Sushchyk S, Xi ZX, Wang JB. Combination of Levo-Tetrahydropalmatine and Low Dose Naltrexone: A Promising Treatment for Prevention of Cocaine Relapse. J Pharmacol Exp Ther 2016; 357:248-57. [PMID: 26903543 DOI: 10.1124/jpet.115.229542] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 02/19/2016] [Indexed: 01/23/2023] Open
Abstract
Relapse to drug use is often cited as the major obstacle in overcoming a drug addiction. Whereas relapse can occur for a myriad of reasons, it is well established that complex neuroadaptations that occur over the course of addiction are major factors. Cocaine, as a potent dopamine transporter blocker, specifically induces alterations in the dopaminergic as well as other monoaminergic neurotransmissions, which lead to cocaine abuse and dependence. Evidence also suggests that adaptations in the endogenous opioids play important roles in pathophysiology of cocaine addiction. Following this evidence, we investigated a combination medication, levo-tetrahydropalmatine (l-THP) and low dose naltrexone (LDN), targeting primarily dopaminergic and endogenous opioid systems as a cocaine-relapse-prevention treatment. In the present study Wistar rats were used to assess the effects ofl-THP and LDN on cocaine self-administration, drug-seeking behavior during cocaine reinstatement, spontaneous locomotion, and effects on the endogenous opioid system. We determined that the combination ofl-THP and LDN reduces drug-seeking behavior during reinstatement more potently thanl-THP alone. Additionally, the combination ofl-THP and LDN attenuates the sedative locomotor effect induced byl-THP. Furthermore, we revealed that treatment with the combination ofl-THP and LDN has an upregulatory effect on both plasmaβ-endorphin and hypothalamic POMC that was not observed inl-THP-treated groups. These results suggest that the combination ofl-THP and LDN has great potential as an effective and well-tolerated medication for cocaine relapse prevention.
Collapse
Affiliation(s)
- Sarah Sushchyk
- Department of Pharmaceutical Sciences, University of Maryland Baltimore, Baltimore, Maryland (S.S., J.B.W.); Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, Maryland (Z.-X.X.)
| | - Zheng-Xiong Xi
- Department of Pharmaceutical Sciences, University of Maryland Baltimore, Baltimore, Maryland (S.S., J.B.W.); Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, Maryland (Z.-X.X.)
| | - Jia Bei Wang
- Department of Pharmaceutical Sciences, University of Maryland Baltimore, Baltimore, Maryland (S.S., J.B.W.); Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, Maryland (Z.-X.X.)
| |
Collapse
|
17
|
Windsor LC, Jemal A, Alessi E. Cognitive behavioral therapy: a meta-analysis of race and substance use outcomes. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2015; 21:300-13. [PMID: 25285527 PMCID: PMC4589258 DOI: 10.1037/a0037929] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Cognitive behavioral therapy (CBT) is an effective intervention for reducing substance use. However, because CBT trials have included predominantly White samples caution must be used when generalizing these effects to Blacks and Hispanics. This meta-analysis compared the impact of CBT in reducing substance use between studies with a predominantly non-Hispanic White sample (hereafter NHW studies) and studies with a predominantly Black and/or Hispanic sample (hereafter BH studies). From 322 manuscripts identified in the literature, 16 met criteria for inclusion. Effect sizes between CBT and comparison group at posttest had similar effects on substance abuse across NHW and BH studies. However, when comparing pre-posttest effect sizes from groups receiving CBT between NHW and BH studies, CBT's impact was significantly stronger in NHW studies. T-test comparisons indicated reduced retention/engagement in BH studies, albeit failing to reach statistical significance. Results highlight the need for further research testing CBT's impact on substance use among Blacks and Hispanics.
Collapse
Affiliation(s)
- Liliane Cambraia Windsor
- Rutgers: The State University of New Jersey, School of Social Work, 360 Martin Luther King Jr. Blvd, Hill Hall, Room 401, Newark, NJ 07104 - USA
| | - Alexis Jemal
- Rutgers: The State University of New Jersey, School of Social Work, 360 Martin Luther King Jr. Blvd, Hill Hall, Room 401, Newark, NJ 07104 - USA
| | - Edward Alessi
- Rutgers: The State University of New Jersey, School of Social Work, 360 Martin Luther King Jr. Blvd, Hill Hall, Room 401, Newark, NJ 07104 - USA
| |
Collapse
|
18
|
Lin SK. Pharmacological means of reducing human drug dependence: a selective and narrative review of the clinical literature. Br J Clin Pharmacol 2014; 77:242-52. [PMID: 23701272 DOI: 10.1111/bcp.12163] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 04/28/2013] [Indexed: 12/20/2022] Open
Abstract
Substance abuse or addictive disorder is a global problem. A greater understanding of the associated changes in brain pathophysiology supports the notion that pharmacological treatments are part of the necessary treatment options. Craving is a core symptom of addictive disorder. It refers to a strong desire to use drugs again either to re-experience positive effects or to diminish negative experiences. Currently there are a number of medicines that are effective in the treatment of addictive disorders. These medications can either be for substitution (same pharmacological effect as the abused substance) or anticraving (decrease the craving of the abused substance). In this MEDLNE based review, specific compounds (naltrexone, acamprosate, topiramate, disulfiram, baclofen, N-acetylcysteine and bupropion) were selected that are known to diminish desire to use (anticraving effect) and that have been trialled for a number of different substance addictive disorders. Their therapeutic potential in clinical practice is discussed in light of their efficacy.
Collapse
Affiliation(s)
- Shih-Ku Lin
- Department of Psychiatry, Taipei City Hospital and Psychiatric Center, Taipei, Taiwan; Department of Psychiatry, School of Medicine, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
19
|
Pettinati HM, Kampman KM, Lynch KG, Dundon WD, Mahoney EM, Wierzbicki MR, O'Brien CP. A pilot trial of injectable, extended-release naltrexone for the treatment of co-occurring cocaine and alcohol dependence. Am J Addict 2014; 23:591-7. [PMID: 25251201 DOI: 10.1111/j.1521-0391.2014.12146.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 04/21/2014] [Accepted: 05/01/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There is a high co-occurrence of cocaine and alcohol use disorders, and patients with both of these problems are difficult to treat. There is a reasonable rationale and some empirical data to justify a pilot trial of an injectable, extended-release formulation of naltrexone for treating co-occurring cocaine and alcohol addiction. METHODS Eighty cocaine (n = 80) and alcohol dependent, treatment-seeking subjects were randomly assigned to receive either two monthly extended-release injections of naltrexone or two matching placebo injections in an 8-week clinical trial, with weekly medical management plus cognitive behavioral therapy visits. RESULTS No differences in reduction in cocaine or alcohol use were observed between the injectable naltrexone and placebo groups during the 8-week trial. CONCLUSIONS Injectable extended-release naltrexone, while an ideal method for ensuring medication adherence in these traditionally hard-to-treat patients, did not result in any measurable reduction in cocaine or alcohol use over the course of 8 weeks of treatment.
Collapse
Affiliation(s)
- Helen M Pettinati
- Department of Psychiatry, Center for the Studies of Addiction, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | | | | | | | | | | | | |
Collapse
|
20
|
Farronato NS, Dürsteler-Macfarland KM, Wiesbeck GA, Petitjean SA. A systematic review comparing cognitive-behavioral therapy and contingency management for cocaine dependence. J Addict Dis 2014; 32:274-87. [PMID: 24074193 DOI: 10.1080/10550887.2013.824328] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The main objective of this review was to compare the effectiveness of cognitive-behavioral therapy and contingency management for cocaine dependence. Contingency management alone reliably reduced cocaine use during active treatment in all cited trials, whereas the positive effect of cognitive-behavioral therapy emerged after treatment in 3 of 5 trials. Synergistic effects of the combination of contingency management plus cognitive-behavioral therapy are shown in 2 trials, but another 3 trials found no additive effects. Positive, rapid, and enduring effects on cocaine use are reliably seen with contingency management interventions, whereas measurable effects of cognitive-behavioral therapy emerge after treatment and are not as reliable as effects with contingency management.
Collapse
Affiliation(s)
- Nadine S Farronato
- a Psychiatric Hospital of the University of Basel , Division of Substance Use Disorders , Basel , Switzerland
| | | | | | | |
Collapse
|
21
|
Schmitz JM, Green CE, Stotts AL, Lindsay JA, Rathnayaka NS, Grabowski J, Moeller FG. A two-phased screening paradigm for evaluating candidate medications for cocaine cessation or relapse prevention: modafinil, levodopa-carbidopa, naltrexone. Drug Alcohol Depend 2014; 136:100-7. [PMID: 24424425 PMCID: PMC3944935 DOI: 10.1016/j.drugalcdep.2013.12.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/15/2013] [Accepted: 12/17/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cocaine pharmacotherapy trials are often confounded by considerable variability in baseline cocaine-use levels, obscuring possible medication efficacy. Testing the feasibility of using a prerandomization, abstinence-induction protocol, we screened three candidate medications to explore treatment response in patients who did, or did not, achieve abstinence during an extended baseline phase. METHOD Eligible treatment-seeking, cocaine-dependent subjects entered a 4-week baseline period (Phase I) with high-value abstinence contingent vouchers and two motivational interviewing sessions, followed by a 12-week medication trial (Phase II) with random assignment stratified on Phase I abstinence status to (1) modafinil (400mg/d), (2) levodopa/carbidopa (800/200mg/d), (3) naltrexone (50mg/d), or (4) placebo. Treatment consisted of thrice-weekly clinic visits for urine benzoylecgonine testing and weekly cognitive behavioral therapy with contingency management targeting medication compliance. RESULTS Of the 118 subjects enrolled, 81 (80%) completed Phase I, with 33 (41%) achieving abstinence, defined a priori as 6 consecutive cocaine-negative urines. Tests of the interaction of each medication (active versus placebo) by baseline status (abstinent versus nonabstinent) permitted moderator effect analysis. Overall, baseline abstinence predicted better outcome. Cocaine-use outcomes for levodopa and naltrexone treatment differed as a function of Phase I abstinence status, with both medications producing benefit in nonabstinent but not baseline-abstinent subjects. There was no evidence of a moderator effect for modafinil. CONCLUSIONS The two-phase screening trial demonstrated that subgrouping of patients with respect to baseline abstinence status is feasible and clinically useful for exploring cocaine cessation and relapse-prevention effects of candidate medications.
Collapse
Affiliation(s)
- Joy M. Schmitz
- Department of Psychiatry and Behavioral Sciences, University of Texas, Houston
| | - Charles E. Green
- Center for Clinical Research & Evidence-Based Medicine, University of Texas, Houston
| | - Angela L. Stotts
- Department of Family and Community Medicine, University of Texas, Houston
| | - Jan A. Lindsay
- Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine,Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center,Houston VA Health Services Research & Development Center of Excellence
| | - Nuvan S. Rathnayaka
- Department of Psychiatry and Behavioral Sciences, University of Texas, Houston
| | - John Grabowski
- Department of Psychiatry, Medical School, University of Minnesota
| | - F. G. Moeller
- Department of Psychiatry, Virginia Commonwealth University
| |
Collapse
|
22
|
Comer SD, Mogali S, Saccone PA, Askalsky P, Martinez D, Walker EA, Jones JD, Vosburg SK, Cooper ZD, Roux P, Sullivan MA, Manubay JM, Rubin E, Pines A, Berkower EL, Haney M, Foltin RW. Effects of acute oral naltrexone on the subjective and physiological effects of oral D-amphetamine and smoked cocaine in cocaine abusers. Neuropsychopharmacology 2013; 38:2427-38. [PMID: 23736314 PMCID: PMC3799062 DOI: 10.1038/npp.2013.143] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 05/04/2013] [Accepted: 05/13/2013] [Indexed: 11/09/2022]
Abstract
Despite the prevalent worldwide abuse of stimulants, such as amphetamines and cocaine, no medications are currently approved for treating this serious public health problem. Both preclinical and clinical studies suggest that the opioid antagonist naltrexone (NTX) is effective in reducing the abuse liability of amphetamine, raising the question of whether similar positive findings would be obtained for cocaine. The purpose of this study was to evaluate the ability of oral NTX to alter the cardiovascular and subjective effects of D-amphetamine (D-AMPH) and cocaine (COC). Non-treatment-seeking COC users (N=12) completed this 3-week inpatient, randomized, crossover study. Participants received 0, 12.5, or 50 mg oral NTX 60 min before active or placebo stimulant administration during 10 separate laboratory sessions. Oral AMPH (0, 10, and 20 mg; or all placebo) was administered in ascending order within a laboratory session using a 60-min interdose interval. Smoked COC (0, 12.5, 25, and 50 mg; or all placebo) was administered in ascending order within a laboratory session using a 14-min interdose interval. Active COC and AMPH produced dose-related increases in cardiovascular function that were of comparable magnitude. In contrast, COC, but not AMPH, produced dose-related increases in several subjective measures of positive drug effect (eg, high, liking, and willingness to pay for the drug). NTX did not alter the cardiovascular effects of AMPH or COC. NTX also did not alter positive subjective ratings after COC administration, but it did significantly reduce ratings of craving for COC and tobacco during COC sessions. These results show that (1) oral AMPH produces minimal abuse-related subjective responses in COC smokers, and (2) NTX reduces craving for COC and tobacco during COC sessions. Future studies should continue to evaluate NTX as a potential anti-craving medication for COC dependence.
Collapse
Affiliation(s)
- Sandra D Comer
- Department of Psychiatry, Division on Substance Abuse, New York State Psychiatric Institute, and College of Physicians and Surgeons, Columbia University, New York, NY, USA,Division on Substance Abuse, New York State Psychiatric Institute, and College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, Unit 120, New York, NY 10032, USA, Tel: +1 212 543 5981, Fax: +1 212 543 5991, E-mail:
| | - Shanthi Mogali
- Department of Psychiatry, Division on Substance Abuse, New York State Psychiatric Institute, and College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Phillip A Saccone
- Department of Pharmacology, University of Michigan, Ann Arbor, MI, USA
| | - Paula Askalsky
- Department of Psychiatry, Division on Substance Abuse, New York State Psychiatric Institute, and College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Diana Martinez
- Department of Psychiatry, Division on Substance Abuse, New York State Psychiatric Institute, and College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Ellen A Walker
- Department of Pharmaceutical Sciences, School of Pharmacy, Temple University, Philadelphia, PA, USA
| | - Jermaine D Jones
- Department of Psychiatry, Division on Substance Abuse, New York State Psychiatric Institute, and College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Suzanne K Vosburg
- Department of Psychiatry, Division on Substance Abuse, New York State Psychiatric Institute, and College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Ziva D Cooper
- Department of Psychiatry, Division on Substance Abuse, New York State Psychiatric Institute, and College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Perrine Roux
- Department of SESSTIM, Institut National de la Sante et de la Recherche Medicale, U912 (SE4S), Marseilles, France
| | - Maria A Sullivan
- Department of Psychiatry, Division on Substance Abuse, New York State Psychiatric Institute, and College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Jeanne M Manubay
- Department of Psychiatry, Division on Substance Abuse, New York State Psychiatric Institute, and College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Eric Rubin
- Department of Psychiatry, Division on Substance Abuse, New York State Psychiatric Institute, and College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Abigail Pines
- Department of Psychiatry, Division on Substance Abuse, New York State Psychiatric Institute, and College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Emily L Berkower
- Department of Psychiatry, Division on Substance Abuse, New York State Psychiatric Institute, and College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Margaret Haney
- Department of Psychiatry, Division on Substance Abuse, New York State Psychiatric Institute, and College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Richard W Foltin
- Department of Psychiatry, Division on Substance Abuse, New York State Psychiatric Institute, and College of Physicians and Surgeons, Columbia University, New York, NY, USA
| |
Collapse
|
23
|
Placebo group improvement in trials of pharmacotherapies for alcohol use disorders: a multivariate meta-analysis examining change over time. J Clin Psychopharmacol 2013; 33:649-57. [PMID: 23857312 PMCID: PMC4076955 DOI: 10.1097/jcp.0b013e3182983e73] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Placebo group improvement in pharmacotherapy trials has been increasing over time across several pharmacological treatment areas. However, it is unknown to what degree increasing improvement has occurred in pharmacotherapy trials for alcohol use disorders or what factors may account for placebo group improvement. This meta-analysis of 47 alcohol pharmacotherapy trials evaluated (1) the magnitude of placebo group improvement, (2) the extent to which placebo group improvement has been increasing over time, and (3) several potential moderators that might account for variation in placebo group improvement. METHOD Random-effects univariate and multivariate analyses were conducted that examined the magnitude of placebo group improvement in the 47 studies and several potential moderators of improvement: (a) publication year, (b) country in which the study was conducted, (c) outcome data source/type, (d) number of placebo administrations, (e) overall severity of study participants, and (f) additional psychosocial treatment. RESULTS Substantial placebo group improvement was found overall and improvement was larger in more recent studies. Greater improvement was found on moderately subjective outcomes, with more frequent administrations of the placebo, and in studies with greater participant severity of illness. However, even after controlling for these moderators, placebo group improvement remained significant, as did placebo group improvement over time. CONCLUSIONS Similar to previous pharmacotherapy placebo research, substantial pretest to posttest placebo group improvement has occurred in alcohol pharmacotherapy trials, an effect that has been increasing over time. However, several plausible moderator variables were not able to explain why placebo group improvement has been increasing over time.
Collapse
|
24
|
Maisel NC, Blodgett JC, Wilbourne PL, Humphreys K, Finney JW. Meta-analysis of naltrexone and acamprosate for treating alcohol use disorders: when are these medications most helpful? Addiction 2013; 108:275-93. [PMID: 23075288 PMCID: PMC3970823 DOI: 10.1111/j.1360-0443.2012.04054.x] [Citation(s) in RCA: 252] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 02/14/2012] [Accepted: 08/09/2012] [Indexed: 12/11/2022]
Abstract
AIMS Although debates over the efficacy of oral naltrexone and acamprosate in treating alcohol use disorders tend to focus on their global efficacy relative to placebo or their efficacy relative to each other, the underlying reality may be more nuanced. This meta-analysis examined when naltrexone and acamprosate are most helpful by testing: (i) the relative efficacy of each medication given its presumed mechanism of action (reducing heavy drinking versus fostering abstinence) and (ii) whether different ways of implementing each medication (required abstinence before treatment, detoxification before treatment, goal of treatment, length of treatment, dosage) moderate its effects. METHODS A systematic literature search identified 64 randomized, placebo-controlled, English-language clinical trials completed between 1970 and 2009 focused on acamprosate or naltrexone. RESULTS Acamprosate had a significantly larger effect size than naltrexone on the maintenance of abstinence, and naltrexone had a larger effect size than acamprosate on the reduction of heavy drinking and craving. For naltrexone, requiring abstinence before the trial was associated with larger effect sizes for abstinence maintenance and reduced heavy drinking compared with placebo. For acamprosate, detoxification before medication administration was associated with better abstinence outcomes compared with placebo. CONCLUSIONS In treatment for alcohol use disorders, acamprosate has been found to be slightly more efficacious in promoting abstinence and naltrexone slightly more efficacious in reducing heavy drinking and craving. Detoxification before treatment or a longer period of required abstinence before treatment is associated with larger medication effects for acamprosate and naltrexone respectively.
Collapse
Affiliation(s)
- Natalya C. Maisel
- Center for Health Care Evaluation, VA Palo Alto Health Care System (152MPD), 795 Willow Rd., Menlo Park, CA 94025
| | - Janet C. Blodgett
- Center for Health Care Evaluation, VA Palo Alto Health Care System (152MPD), 795 Willow Rd., Menlo Park, CA 94025
| | - Paula L. Wilbourne
- Center for Health Care Evaluation, VA Palo Alto Health Care System (152MPD), 795 Willow Rd., Menlo Park, CA 94025
| | - Keith Humphreys
- Center for Health Care Evaluation, VA Palo Alto Health Care System (152MPD), 795 Willow Rd., Menlo Park, CA 94025,Stanford University Stanford School of Medicine, Department of Psychiatry & Behavioral Sciences, 401 N. Quarry Road, Stanford, CA 94305-5717
| | - John W. Finney
- Center for Health Care Evaluation, VA Palo Alto Health Care System (152MPD), 795 Willow Rd., Menlo Park, CA 94025,Stanford University Stanford School of Medicine, Department of Psychiatry & Behavioral Sciences, 401 N. Quarry Road, Stanford, CA 94305-5717
| |
Collapse
|
25
|
Cocaine reverses the naltrexone-induced reduction in operant ethanol self-administration: The effects on immediate-early gene expression in the rat prefrontal cortex. Neuropharmacology 2012; 63:927-35. [DOI: 10.1016/j.neuropharm.2012.06.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Revised: 05/19/2012] [Accepted: 06/07/2012] [Indexed: 12/20/2022]
|
26
|
Lingford-Hughes AR, Welch S, Peters L, Nutt DJ. BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP. J Psychopharmacol 2012; 26:899-952. [PMID: 22628390 DOI: 10.1177/0269881112444324] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The British Association for Psychopharmacology guidelines for the treatment of substance abuse, harmful use, addiction and comorbidity with psychiatric disorders primarily focus on their pharmacological management. They are based explicitly on the available evidence and presented as recommendations to aid clinical decision making for practitioners alongside a detailed review of the evidence. A consensus meeting, involving experts in the treatment of these disorders, reviewed key areas and considered the strength of the evidence and clinical implications. The guidelines were drawn up after feedback from participants. The guidelines primarily cover the pharmacological management of withdrawal, short- and long-term substitution, maintenance of abstinence and prevention of complications, where appropriate, for substance abuse or harmful use or addiction as well management in pregnancy, comorbidity with psychiatric disorders and in younger and older people.
Collapse
|
27
|
Kufahl PR, Olive MF. Investigating Methamphetamine Craving Using the Extinction-Reinstatement Model in the Rat. JOURNAL OF ADDICTION RESEARCH & THERAPY 2011; S1:003. [PMID: 22428089 PMCID: PMC3305273 DOI: 10.4172/2155-6105.s1-003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Like all other drugs of abuse, the primary therapeutic objective for treating methamphetamine addiction research is the maintenance of abstinence and prevention of relapse to habitual drug-taking. Compounds with the potential to prevent relapse are often investigated in rats that are trained to self-administer intravenous methamphetamine, subjected to extinction training where responding is no longer reinforced, and then given tests for reinstatement of drug-seeking behavior triggered by methamphetamine injections or re-exposure to drug-paired cues. Experimental compounds are administered to the animals prior to the reinstatement tests to evaluate their potential for attenuating or preventing drug-seeking behavior. This article describes the common procedures of the extinction-reinstatement model in studies of this type, and identifies areas of discrepancy. This is followed by a comprehensive overview of the currently published anti-reinstatement effects of pharmacological compounds, classified by the most relevant neurological systems associated with these compounds. The article concludes with a brief discussion of how the study of anti-reinstatement effects can be expanded to further verify existing positive results or to find novel neurobiological targets.
Collapse
Affiliation(s)
- Peter R. Kufahl
- Department of Psychology, Arizona State University, Tempe, AZ85287, USA
| | - M. Foster Olive
- Department of Psychology, Arizona State University, Tempe, AZ85287, USA
| |
Collapse
|
28
|
Reece AS. Hypothalamic opioid-melanocortin appetitive balance and addictive craving. Med Hypotheses 2011; 76:132-7. [PMID: 20926200 DOI: 10.1016/j.mehy.2010.09.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 08/17/2010] [Accepted: 09/06/2010] [Indexed: 10/19/2022]
Abstract
Whilst the parallels between drug and food craving are receiving increasing attention, the recently elucidated complex physiology of the hypothalamic appetite regulatory centres has been largely overlooked in the efforts to understand drug craving which is one of the most refractory and problematic aspects of drug and behavioural addictions. Important conceptual gains could be made by researchers from both appetite and addiction neuroscience if they were to have an improved understanding of each others' disciplines. It is well known in addiction medicine that the use of many substances is elevated in opiate dependency. There is voluminous evidence of very high rates of drug use in opiate agonist maintained patients, and the real possibility exists that opiate agonist therapy therefore increases drug craving. Conversely, opiate antagonist therapy with naloxone or naltrexone has been shown to reduce most chemical and behavioural addictions, and naltrexone is now being developed together with bupropion as the anti-obesity drug "Contrave". Hypothalamic melanocortins, particularly α-MSH, are known to constitute the main brake to consumptive behaviour of food. There is a well described antagonism between melanocortins and opioids at many loci including the hypothalamus. Administration of exogenous opiates is known to both suppress α-MSH and to stimulate hedonic food consumption. Opiate maintenance programs are associated with weight gain. As monoamines, opioids and cannabinoids are known to be involved in appetite regulation, and as endorphin opioids are known to be perturbed in other addictions, further exploration of the hypothalamic appetite regulatory centre would appear to be an obvious, albeit presently largely overlooked, locus in which to study drug and other craving mechanisms.
Collapse
Affiliation(s)
- Albert Stuart Reece
- University of Western Australia, Clinical Neurosciences, 39 Gladstone Rd., Highgate Hill, Brisbane, Queensland 4101, Australia.
| |
Collapse
|
29
|
Rösner S, Hackl-Herrwerth A, Leucht S, Vecchi S, Srisurapanont M, Soyka M. Opioid antagonists for alcohol dependence. Cochrane Database Syst Rev 2010:CD001867. [PMID: 21154349 DOI: 10.1002/14651858.cd001867.pub3] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Alcohol dependence belongs to the globally leading health risk factors. Therapeutic success of psychosocial programs for relapse prevention is moderate and could be increased by an adjuvant treatment with the opioid antagonists naltrexone and nalmefene. OBJECTIVES To determine the effectiveness and tolerability of opioid antagonists in the treatment of alcohol dependence. SEARCH STRATEGY We searched the Cochrane Drugs and Alcohol Group (CDAG) Specialized Register, PubMed, EMBASE and CINAHL in January 2010 and inquired manufacturers and researchers for unpublished trials. SELECTION CRITERIA All double-blind randomised controlled trials (RCTs) which compare the effects of naltrexone or nalmefene with placebo or active control on drinking-related outcomes. DATA COLLECTION AND ANALYSIS Two authors independently extracted outcome data. Trial quality was assessed by one author and cross-checked by a second author. MAIN RESULTS Based on a total of 50 RCTs with 7793 patients, naltrexone reduced the risk of heavy drinking to 83% of the risk in the placebo group RR 0.83 (95% CI 0.76 to 0.90) and decreased drinking days by about 4%, MD -3.89 (95% CI -5.75 to -2.04). Significant effects were also demonstrated for the secondary outcomes of the review including heavy drinking days, MD - 3.25 (95% CI -5.51 to -0.99), consumed amount of alcohol, MD - 10.83 (95% CI -19.69 to -1.97) and gamma-glutamyltransferase, MD - 10.37 (95% CI -18.99 to -1.75), while effects on return to any drinking, RR 0.96 (95 CI 0.92 to 1.00) missed statistical significance. Side effects of naltrexone were mainly gastrointestinal problems (e.g. nausea: RD 0.10; 95% CI 0.07 to 0.13) and sedative effects (e.g. daytime sleepiness: RD 0.09; 95% CI 0.05 to 0.14). Based on a limited study sample, effects of injectable naltrexone and nalmefene missed statistical significance. Effects of industry-sponsored studies, RR 0.90 (95% CI 0.78 to 1.05) did not significantly differ from those of non-profit funded trials, RR 0.84 (95% CI 0.77 to 0.91) and the linear regression test did not indicate publication bias (P = 0.765). AUTHORS' CONCLUSIONS Naltrexone appears to be an effective and safe strategy in alcoholism treatment. Even though the sizes of treatment effects might appear moderate in their magnitudes, these should be valued against the background of the relapsing nature of alcoholism and the limited therapeutic options currently available for its treatment.
Collapse
Affiliation(s)
- Susanne Rösner
- Psychiatric Hospital, University of Munich, Nußbaumstr. 7, Munich, Germany, 80336
| | | | | | | | | | | |
Collapse
|
30
|
Abstract
This paper is the 32nd consecutive installment of the annual review of research concerning the endogenous opioid system. It summarizes papers published during 2009 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 (Section 2), and the roles of these opioid peptides and receptors in pain and analgesia (Section 3); stress and social status (Section 4); tolerance and dependence (Section 5); learning and memory (Section 6); eating and drinking (Section 7); alcohol and drugs of abuse (Section 8); sexual activity and hormones, pregnancy, development and endocrinology (Section 9); mental illness and mood (Section 10); seizures and neurologic disorders (Section 11); electrical-related activity and neurophysiology (Section 12); general activity and locomotion (Section 13); gastrointestinal, renal and hepatic functions (Section 14); cardiovascular responses (Section 15); respiration and thermoregulation (Section 16); and immunological responses (Section 17).
Collapse
Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, 65-30 Kissena Blvd., Flushing, NY 11367, USA.
| |
Collapse
|
31
|
Reece AS. Clinical safety of 1500 mg oral naltrexone overdose. BMJ Case Rep 2010; 2010:2010/sep06_1/bcr0420102871. [PMID: 22778191 DOI: 10.1136/bcr.04.2010.2871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
This case represents a clinical overdose of the largest known dose of oral naltrexone, equivalent to the taking of a whole bottle of the oral naltrexone preparation. The patient's intention was to control craving for alcohol and opiates. The patient quickly settled with expectant management. As such it demonstrates that earlier concerns that have been voiced in this area, particularly relating to naltrexone-related hepatotoxicity and depression, may have been overstated, at least in the experience of this patient. This patient's course was marked only by gastric irritation, of which she had some history. As such the present profile provides case report evidence consistent with more robust views of the patient safety of naltrexone itself, and opposing more cautious views. Her polydrug craving was suppressed for a period of 2 weeks, which raises the important question of the mechanism of action of naltrexone's generalised suppression of refractory hedonic consumptive addictive behaviours.
Collapse
|