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Zoob Carter BN, Boardley ID. Development and validation of dependence and craving measures specific to athletes who use anabolic-androgenic steroids. Front Psychol 2024; 15:1347211. [PMID: 39176050 PMCID: PMC11339692 DOI: 10.3389/fpsyg.2024.1347211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 07/11/2024] [Indexed: 08/24/2024] Open
Abstract
Background Anabolic-androgenic steroid (AAS) dependence affects approximately 30% of people who use AAS. Presently, measures to assess and diagnose AAS dependence are adapted from scales specific to other forms of drug misuse (e.g., alcohol), containing issues with internal consistency and breadth of construct capture. Additionally, there are no measures available to assess AAS craving, which represents a potentially important coeval factor to AAS dependence. Therefore, this study aimed to develop and provide evidence of validity for measures of AAS dependence and AAS craving. Methods Data were collected from male and female strength athletes who use AAS across two samples (n sample 1 = 206; n sample 2 = 224). Sample 1 completed the new measures alongside instruments assessing theoretically related constructs (Doping Moral Disengagement, Doping Self-Regulatory Efficacy Scale, craving items from the Wisconsin Smoking Withdrawal Scale, AAS adapted Diagnostic and Statistical Manual for Mental Disorder 4th Edition), whereas Sample 2 completed the new instruments. Results Exploratory and Confirmatory Factor Analyses (CFA) with Sample 1 data were used to finalize the item sets for both measures and determine the factorial structures of the AAS Dependence Scale (AASDS) and AAS Craving Scale (AASCS). The AASDS consists of 15-items across five first-order factors that are represented by one second-order factor. The AASCS consists of 16-items across four first-order factors that are represented by one second-order factor. Evidence supporting the concurrent, convergent and discriminant validity of scores obtained with both scales was provided through their associations with the theoretically related variables. CFA with the data from Sample 2 confirmed the factor structures for both scales. Conclusion The AASDS and AASCS represent valid and reliable measures of AAS dependence and AAS craving for use in research with strength athletes who use AAS.
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Freet CS, Evans B, Brick TR, Deneke E, Wasserman EJ, Ballard SM, Stankoski DM, Kong L, Raja-Khan N, Nyland JE, Arnold AC, Krishnamurthy VB, Fernandez-Mendoza J, Cleveland HH, Scioli AD, Molchanow A, Messner AE, Ayaz H, Grigson PS, Bunce SC. Ecological momentary assessment and cue-elicited drug craving as primary endpoints: study protocol for a randomized, double-blind, placebo-controlled clinical trial testing the efficacy of a GLP-1 receptor agonist in opioid use disorder. Addict Sci Clin Pract 2024; 19:56. [PMID: 39061093 PMCID: PMC11282646 DOI: 10.1186/s13722-024-00481-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 06/07/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Despite continuing advancements in treatments for opioid use disorder (OUD), continued high rates of relapse indicate the need for more effective approaches, including novel pharmacological interventions. Glucagon-like peptide 1 receptor agonists (GLP-1RA) provide a promising avenue as a non-opioid medication for the treatment of OUD. Whereas GLP-1RAs have shown promise as a treatment for alcohol and nicotine use disorders, to date, no controlled clinical trials have been conducted to determine if a GLP-1RA can reduce craving in individuals with OUD. The purpose of the current protocol was to evaluate the potential for a GLP-1RA, liraglutide, to safely and effectively reduce craving in an OUD population in residential treatment. METHOD This preliminary study was a randomized, double-blinded, placebo-controlled clinical trial designed to test the safety and efficacy of the GLP-1RA, liraglutide, in 40 participants in residential treatment for OUD. Along with taking a range of safety measures, efficacy for cue-induced craving was evaluated prior to (Day 1) and following (Day 19) treatment using a Visual Analogue Scale (VAS) in response to a cue reactivity task during functional near-infrared spectroscopy (fNIRS) and for craving. Efficacy of treatment for ambient craving was assessed using Ecological Momentary Assessment (EMA) prior to (Study Day 1), across (Study Days 2-19), and following (Study Days 20-21) residential treatment. DISCUSSION This manuscript describes a protocol to collect clinical data on the safety and efficacy of a GLP-1RA, liraglutide, during residential treatment of persons with OUD, laying the groundwork for further evaluation in a larger, outpatient OUD population. Improved understanding of innovative, non-opioid based treatments for OUD will have the potential to inform community-based interventions and health policy, assist physicians and health care professionals in the treatment of persons with OUD, and to support individuals with OUD in their effort to live a healthy life. TRIAL REGISTRATION ClinicalTrials.gov: NCT04199728. Registered 16 December 2019, https://clinicaltrials.gov/study/NCT04199728?term=NCT04199728 . PROTOCOL VERSION 10 May 2023.
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Affiliation(s)
- Christopher S Freet
- Department of Psychiatry and Behavioral Health, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Brianna Evans
- Department of Neural and Behavioral Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Timothy R Brick
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
- Institute for Computational and Data Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Erin Deneke
- Fran and Doug Tieman Center for Research, Caron Treatment Centers, Wernersville, PA, USA
| | - Emily J Wasserman
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Sarah M Ballard
- Department of Neural and Behavioral Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Dean M Stankoski
- Fran and Doug Tieman Center for Research, Caron Treatment Centers, Wernersville, PA, USA
| | - Lan Kong
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Nazia Raja-Khan
- Department of Psychiatry and Behavioral Health, The Pennsylvania State University College of Medicine, Hershey, PA, USA
- Department of Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, USA
- Department of Obstetrics & Gynecology, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Jennifer E Nyland
- Department of Neural and Behavioral Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Amy C Arnold
- Department of Neural and Behavioral Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Venkatesh Basappa Krishnamurthy
- Department of Medicine and Psychiatry, Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Julio Fernandez-Mendoza
- Department of Psychiatry and Behavioral Health, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - H Harrington Cleveland
- Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA
| | - Adam D Scioli
- Fran and Doug Tieman Center for Research, Caron Treatment Centers, Wernersville, PA, USA
| | | | | | - Hasan Ayaz
- School of Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA, USA
| | - Patricia S Grigson
- Department of Neural and Behavioral Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
| | - Scott C Bunce
- Department of Psychiatry and Behavioral Health, The Pennsylvania State University College of Medicine, Hershey, PA, USA.
- Penn State University College of Medicine, Milton S. Hershey Medical Center, H073, 500 University Drive, Hershey, PA, 17033-0850, USA.
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Türker ZG, Erdoğan A, Cinemre B, Metin Ö, Kulaksızoğlu B. Comparative evaluation of craving, sleep quality, sexual function and quality of life in opioid use disorder patients in remission with buprenorphine/naloxone maintenance treatment. Hum Psychopharmacol 2024:e2908. [PMID: 39003581 DOI: 10.1002/hup.2908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 07/02/2024] [Accepted: 07/02/2024] [Indexed: 07/15/2024]
Abstract
AIM To compare opioid use disorder (OUD) patients who continue to use opioids and are in remission with buprenorphine-naloxone (B/N) in terms of some parameters and to evaluate the relationship between B/N dose and these parameters. METHOD We included 141 OUD patients in remission with B/N maintenance treatment for at least 6 months, 141 who still used opioids, and 141 healthy volunteers. Substance Craving Scale (SCS), Pittsburgh Sleep Quality Index (PSQI), Arizona Sexual Experiences Scale (ASEX), and Short Form 36 (SF-36) were administered. RESULTS PSQI scores and ASEX scores were higher in those who continued to use opiates than in OUD in remission, and in OUD in remission compared to controls. OUD patients with current opioid use also had lower SF-36 scores compared to both patients in remission and healthy controls. SCS, PSQI, ASEX, and SF-36 scores were similar when the three groups were examined based on the dosage of B/N (below 8, 8-15, and 16 mg/day and above) use in OUD in remission. CONCLUSIONS Quality of life, craving, sleep and sexual functions improved significantly with B/N; however, these effects are not dependent on B/N dosage.
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Affiliation(s)
- Zübeyde Güllü Türker
- Department of Psychiatry, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Ali Erdoğan
- Department of Psychiatry, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Buket Cinemre
- Department of Psychiatry, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Özmen Metin
- Department of Psychiatry, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Burak Kulaksızoğlu
- Department of Psychiatry, Akdeniz University Faculty of Medicine, Antalya, Turkey
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Carter JS, Costa CC, Lewandowski SI, Nelson KH, Goldsmith ST, Scofield MD, Reichel CM. Estrogen receptor beta signaling enhances extinction memory recall for heroin-conditioned cues in a sex- and region-specific manner. Transl Psychiatry 2024; 14:283. [PMID: 38997258 PMCID: PMC11245532 DOI: 10.1038/s41398-024-03001-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/25/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
Return to use, or relapse, is a major challenge in the treatment of opioid use disorder (OUD). Relapse can be precipitated by several factors, including exposure to drug-conditioned cues. Identifying successful treatments to mitigate cue-induced relapse has been challenging, perhaps due to extinction memory recall (EMR) deficits. Previously, inhibition of estradiol (E2) signaling in the basolateral amygdala (BLA) impaired heroin-cue EMR. This effect was recapitulated by antagonism of BLA estrogen receptors (ER) in a sex-specific manner such that blocking ERα in males, but ERβ in females, impaired EMR. However, it is unclear whether increased E2 signaling, in the BLA or systemically, enhances heroin-cue EMR. We hypothesized that ERβ agonism would enhance heroin-cue EMR in a sex- and region-specific manner. To determine the capacity of E2 signaling to improve EMR, we pharmacologically manipulated ERβ across several translationally designed experiments. First, male and female rats acquired heroin or sucrose self-administration. Next, during a cued extinction session, we administered diarylpropionitrile (DPN, an ERβ agonist) and tested anxiety-like behavior on an open field. Subsequently, we assessed EMR in a cue-induced reinstatement test and, finally, measured ERβ expression in several brain regions. Across all experiments, females took more heroin and sucrose than males and had greater responses during heroin-cued extinction. Administration of DPN in the BLA enhanced EMR in females only, driven by ERβ's impacts on memory consolidation. Interestingly, however, systemic DPN administration improved EMR for heroin cues in both sexes across several different tests, but did not impact sucrose-cue EMR. Immunohistochemical analysis of ERβ expression across several different brain regions showed that females only had greater expression of ERβ in the basal nucleus of the BLA. Here, in several preclinical experiments, we demonstrated that ERβ agonism enhances heroin-cue EMR and has potential utility in combatting cue-induced relapse.
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Affiliation(s)
- Jordan S Carter
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, 29425, USA.
| | - Caitlyn C Costa
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Stacia I Lewandowski
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Katharine H Nelson
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Sarah T Goldsmith
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Michael D Scofield
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Carmela M Reichel
- Department of Neuroscience, Medical University of South Carolina, Charleston, SC, 29425, USA.
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McAnulty C, Bastien G, Ledjiar O, Eugenia Socias M, Le Foll B, Lim R, Jutras-Aswad D. Mediating effect of craving on the impact of buprenorphine/naloxone and methadone treatment on opioid use: Results from a randomized controlled trial. Addict Behav 2024; 154:108023. [PMID: 38579594 DOI: 10.1016/j.addbeh.2024.108023] [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: 06/03/2023] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND The relationship between opioid craving and opioid use is unclear. We sought to determine to what extent craving mediated the relationship between opioid agonist therapy and changes in opioid use. METHODS Data came from a pragmatic, 24-week, pan-Canadian, multi-centric, open-label, randomized controlled trial comparing flexible buprenorphine/naloxone take-home doses to standard supervised methadone models of care for the treatment of prescription-type opioid use disorder. Participants were randomly allocated to buprenorphine/naloxone or methadone models of care. 270 people with prescription-type opioid use disorder were included in analyses. There were 93 women (34.4%) and 2 transgender (0.7%) participants. Most participants were white (67.4%), 45.9% reported unstable living conditions, and 44.8% had psychiatric comorbidities. Generalized linear mixed models followed by mediation analysis estimated the direct effect of treatment group on Timeline Followback-reported next-week opioid use and the indirect effect through past 24-hour opioid craving measured using the Brief Substance Craving Scale at week 2, 6, 10, 14, 18 and 22. RESULTS Upon mediation analysis, the average direct effect of treatment on opioid use was 0.465 (95 % CI = 0.183 to 0.751, p < 0.001). The average causal mediated effect was 0.144 (95 % CI = 0.021 to 0.110; p < 0.001). Craving accounted for 23.6 % of the effect of treatment on opioid use (p < 0.001). CONCLUSIONS Past 24-hour craving was associated with increased next-week opioid use; however, craving only partially mediated the effect of buprenorphine/naloxone and methadone on next-week opioid use. Research is needed to develop a comprehensive understanding of factors mediating opioid use during opioid agonist therapy.
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Affiliation(s)
- Christina McAnulty
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada
| | - Gabriel Bastien
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada
| | - Omar Ledjiar
- Unité de recherche Clinique appliquée (URCA), Research Centre, Centre Hospitalier Ste-Justine, 3175 chemin de la Côte Ste-Catherine, Montréal, Québec H3T 1C5, Canada
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, 1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada
| | - Bernard Le Foll
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada; Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario M5S 2S1, Canada; Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Waypoint Research Institute, Waypoint Centre for Mental Health Care, 500 Church Street, Penetanguishene, Ontario L9M 1G3, Canada
| | - Ron Lim
- Department of Psychiatry and Family Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada.
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Truitt B, Tao J, Roy S. Impact of Morphine withdrawal on genes related to the TLR2 pathway expressed in the Prefrontal Cortex. Sci Prog 2024; 107:368504241264994. [PMID: 39228316 PMCID: PMC11375641 DOI: 10.1177/00368504241264994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2024]
Abstract
Millions of people suffer from opioid use disorder, because of the ongoing opioid epidemic. The aversive symptoms of withdrawal are a leading factor for drug relapses, yet there are limited therapeutic options to minimize or prevent withdrawal symptoms. The mechanism behind opioid withdrawal is still not fully understood, thus preventing the development of new therapeutics. This study is an extension of our previously proposed mechanism of a toll-like receptor 2 (TLR2) mediated withdrawal response as a result of morphine induced microbial change that occurs during morphine withdrawal. Transcriptome analysis of the pre-frontal cortex indicated that there was increased expression of genes related to TLR2 signaling in morphine withdrawal treated animals compared to placebo controls. Antibiotic treatment further altered TLR2 related genes, recovering some of the morphine induced effect and leading to additional suppression of some genes related to the TLR2 pathway. Morphine withdrawal induced gene expression was attenuated in a whole body TLR2 knockout model. These results provide more support that TLR2 plays an integral role in morphine withdrawal mechanisms and could be a potential therapeutic target to minimize opioid withdrawal associated co-morbidities.
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Affiliation(s)
- Bridget Truitt
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Junyi Tao
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Sabita Roy
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL, USA
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Segelnick SL, Weinberg MA. Orally dissolving buprenorphine for opioid use disorder linked to caries. J Am Dent Assoc 2024; 155:561-564. [PMID: 38691081 DOI: 10.1016/j.adaj.2024.03.001] [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: 01/02/2024] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Buprenorphine is under scrutiny because of the development of xerostomia and caries. The purpose of this article was to inform dental care professionals about the oral effects of buprenorphine and to increase knowledge and awareness of medication-assisted treatment in the management of opioid use disorder (OUD). CASE DESCRIPTION In 2022, the US Food and Drug Administration issued a warning about xerostomia and caries associated with the use of transmucosal (sublingual and buccal formulations) buprenorphine. Dental health care professionals should instruct patients taking buprenorphine on how to prevent these dental issues by means of rinsing with water and swallowing once the drug has been completely dissolved, followed by toothbrushing at least 1 hour after taking the drug. In addition, a fluoride supplement should be prescribed. PRACTICAL IMPLICATIONS It is imperative for dentists to recognize buprenorphine as medication-assisted treatment and to recognize a patient as having an OUD. While taking buprenorphine, the patient should have more frequent oral health care appointments, including home care instructions and caries risk assessment to monitor for caries and xerostomia so that treatment, if indicated, could be initiated as soon as possible. In addition, the dentist's role in OUD is to make sure patients follow the treatment recommendations and use the buprenorphine and to not have them discontinue because of potential caries risk.
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Ni H, Wang H, Ma X, Li S, Liu C, Song X, Potenza MN, Dong GH. Efficacy and Neural Mechanisms of Mindfulness Meditation Among Adults With Internet Gaming Disorder: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2416684. [PMID: 38888924 PMCID: PMC11185988 DOI: 10.1001/jamanetworkopen.2024.16684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/04/2024] [Indexed: 06/20/2024] Open
Abstract
Importance The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), recently identified internet gaming disorder (IGD) as a condition warranting more research, and few empirically validated treatments exist. Mindfulness meditation (MM) has multiple health benefits; however, its efficacy in treating IGD and potential neural mechanisms underlying MM treatment of the disorder remain largely unknown. Objective To explore the efficacy of MM used to treat adults with IGD and to identify neural mechanisms underlying MM. Design, Setting, and Participants This randomized clinical trial was performed from October 1 to November 30, 2023, at Hangzhou Normal University in Hangzhou, China. Adults (aged ≥18 years) who met at least 6 of the 9 DSM-5-TR proposed criteria for IGD were recruited to receive either MM or progressive muscle relaxation (PMR). Data analysis was performed on December 1, 2023. Intervention Participants underwent MM training (an 8-session meditation program that focuses on attention and acceptance) and PMR training (an 8-time program for body relaxation) delivered in groups that met 2 times each week for 4 weeks. Main Outcomes and Measures This per-protocol analysis included only participants who finished the pretest assessment, 8 training sessions, and posttest assessment. The main outcomes were addiction severity (measured with the DSM-5-TR proposed criteria for IGD and with Internet Addiction Test scores), gaming craving (measured with Questionnaire for Gaming Urges scores), and blood oxygen level-dependent signals assessed with cue-craving tasks on fMRI. Behavioral and brain measurements were compared using analysis of variance. Functional connectivity (FC) among identified brain regions was measured to test connectivity changes associated with MM. Results This study included 64 adults with IGD. A total of 32 participants received MM (mean [SD] age, 20.3 [1.9] years; 17 women [53%]) and 32 received PMR (mean [SD] age, 20.2 [1.5] years; 16 women [50%]). The severity of IGD decreased in the MM group (pretest vs posttest: mean [SD], 7.0 [1.1] vs 3.6 [0.8]; P < .001) and in the PMR group (mean [SD], 7.1 [0.9] vs 6.0 [0.9]; P = .04). The MM group had a greater decrease in IGD severity than the PMR group (mean [SD] score change for the MM group vs the PMR group, -3.6 [0.3] vs -1.1 [0.2]; P < .001). Mindfulness meditation was associated with decreased brain activation in the bilateral lentiform nuclei (r = 0.40; 95% CI, 0.19 to 0.60; P = .02), insula (r = 0.35; 95% CI, 0.09 to 0.60; P = .047), and medial frontal gyrus (MFG; r = 0.43; 95% CI, 0.16 to 0.70; P = .01). Increased MFG-lentiform FC and decreased craving (pretest vs posttest: mean [SD], 58.8 [15.7] vs 33.6 [12.0]; t = -8.66; ƞ2 = 0.30; P < .001) was observed after MM, and changes in MFG-lentiform FC mediated the relationship between increased mindfulness and decreased craving (mediate effect, -0.17; 95% CI, -0.32 to -0.08; P = .03). Conclusions and Relevance In this study, MM was more effective in decreasing addiction severity and gaming cravings compared with PMR. These findings indicate that MM may be an effective treatment for IGD and may exert its effects by altering frontopallidal pathways. Trial Registration Chinese Clinical Trial Registry Identifier: ChiCTR2300075869.
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Affiliation(s)
- Haosen Ni
- Department of Psychology, Yunnan Normal University, Kunming, China
| | - Huabin Wang
- Department of Psychology, Yunnan Normal University, Kunming, China
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China
| | - Xuefeng Ma
- Department of Psychology, Yunnan Normal University, Kunming, China
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China
| | - Shuang Li
- Department of Psychology, Yunnan Normal University, Kunming, China
- Institutes of Psychological Sciences, Hangzhou Normal University, Hangzhou, China
| | - Chang Liu
- NuanCun Mindful-Living Mindfulness Center, Hangzhou, China
| | - Xiaolan Song
- Center of Mindfulness, School of Psychology, Zhejiang Normal University, Jinhua, China
| | - Marc N. Potenza
- Department of Psychiatry and the Child Study Center, Yale University School of Medicine, New Haven, Connecticut
- Department of Neuroscience, Yale University, New Haven, Connecticut
- Connecticut Council on Problem Gambling, Wethersfield
| | - Guang-Heng Dong
- Department of Psychology, Yunnan Normal University, Kunming, China
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Bergeria CL, Gipson CD, Smith KE, Stoops WW, Strickland JC. Opioid craving does not incubate over time in inpatient or outpatient treatment studies: Is the preclinical incubation of craving model lost in translation? Neurosci Biobehav Rev 2024; 160:105618. [PMID: 38492446 PMCID: PMC11046527 DOI: 10.1016/j.neubiorev.2024.105618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024]
Abstract
Within addiction science, incubation of craving is an operational label used to describe time-dependent increases in drug seeking during periods of drug deprivation. The purpose of this systematic review was to describe the preclinical literature on incubation of craving and the clinical literature on craving measured over extended periods of abstinence to document this translational homology and factors impacting correspondence. Across the 44 preclinical studies that met inclusion criteria, 31 reported evidence of greater lever pressing, nose pokes, spout licks, or time spent in drug-paired compartments (i.e., drug seeking) relative to neutral compartments after longer periods of abstinence relative to shorter periods of abstinence, labelled as "incubation of craving." In contrast, no clinical studies (n = 20) identified an increase in opioid craving during longer abstinence periods. The lack of clinical evidence for increases in craving in clinical populations weakens the translational utility of operationalizing the time-dependent increase in drug-seeking behavior observed in preclinical models as models of incubation of "craving".
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Affiliation(s)
- Cecilia L Bergeria
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, United States.
| | - Cassandra D Gipson
- University of Kentucky College of Medicine, Department of Pharmacology and Nutritional Sciences, Lexington, KY, United States
| | - Kirsten E Smith
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, United States
| | - William W Stoops
- University of Kentucky College of Medicine, Department of Behavioral Science, Lexington, KY, United States
| | - Justin C Strickland
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, MD, United States
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King VL, Siegel G, Priesmeyer HR, Siegel LH, Potter JS. Development and Evaluation of a Digital App for Patient Self-Management of Opioid Use Disorder: Usability, Acceptability, and Utility Study. JMIR Form Res 2024; 8:e48068. [PMID: 38557501 PMCID: PMC11019416 DOI: 10.2196/48068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 12/07/2023] [Accepted: 01/11/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Self-management of opioid use disorder (OUD) is an important component of treatment. Many patients receiving opioid agonist treatment in methadone maintenance treatment settings benefit from counseling treatments to help them improve their recovery skills but have insufficient access to these treatments between clinic appointments. In addition, many addiction medicine clinicians treating patients with OUD in a general medical clinic setting do not have consistent access to counseling referrals for their patients. This can lead to decreases in both treatment retention and overall progress in the patient's recovery from substance misuse. Digital apps may help to bridge this gap by coaching, supporting, and reinforcing behavioral change that is initiated and directed by their psychosocial and medical providers. OBJECTIVE This study aimed to conduct an acceptability, usability, and utility pilot study of the KIOS app to address these clinical needs. METHODS We developed a unique, patient-centered computational software system (KIOS; Biomedical Development Corporation) to assist in managing OUD in an outpatient, methadone maintenance clinic setting. KIOS tracks interacting self-reported symptoms (craving, depressed mood, anxiety, irritability, pain, agitation or restlessness, difficulty sleeping, absenteeism, difficulty with usual activities, and conflicts with others) to determine changes in both the trajectory and severity of symptom patterns over time. KIOS then applies a proprietary algorithm to assess the individual's patterns of symptom interaction in accordance with models previously established by OUD experts. After this analysis, KIOS provides specific behavioral advice addressing the individual's changing trajectory of symptoms to help the person self-manage their symptoms. The KIOS software also provides analytics on the self-reported data that can be used by patients, clinicians, and researchers to track outcomes. RESULTS In a 4-week acceptability, usability (mean System Usability Scale-Modified score 89.5, SD 9.2, maximum of 10.0), and utility (mean KIOS utility questionnaire score 6.32, SD 0.25, maximum of 7.0) pilot study of 15 methadone-maintained participants with OUD, user experience, usability, and software-generated advice received high and positive assessment scores. The KIOS clinical variables closely correlated with craving self-report measures. Therefore, managing these variables with advice generated by the KIOS software could have an impact on craving and ultimately substance use. CONCLUSIONS KIOS tracks key clinical variables and generates advice specifically relevant to the patient's current and changing clinical state. Patients in this pilot study assigned high positive values to the KIOS user experience, ease of use, and the appropriateness, relevance, and usefulness of the specific behavioral guidance they received to match their evolving experiences. KIOS may therefore be useful to augment in-person treatment of opioid agonist patients and help fill treatment gaps that currently exist in the continuum of care. A National Institute on Drug Abuse-funded randomized controlled trial of KIOS to augment in-person treatment of patients with OUD is currently being conducted.
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Affiliation(s)
- Van Lewis King
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center San Antonio, San Antonio, TX, United States
| | - Gregg Siegel
- Biomedical Development Corporation, San Antonio, TX, United States
| | | | - Leslie H Siegel
- Biomedical Development Corporation, San Antonio, TX, United States
| | - Jennifer S Potter
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center San Antonio, San Antonio, TX, United States
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11
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Ahn S, Zou H, Seamans JK, Phillips AG. Differential patterns of basal and naloxone-evoked dopamine efflux in the rat dorsal and ventral striatum following prolonged-intermittent exposure to morphine. Eur J Neurosci 2024; 59:1067-1078. [PMID: 37985418 DOI: 10.1111/ejn.16192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/25/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023]
Abstract
Hypodopaminergia in the ventral striatum is a putative neurobiological correlate of withdrawal in opioid-dependent individuals. This perspective stands in contrast to brain imaging studies with chronic opioid users showing that naloxone-enhanced dopamine (DA) release in the dorsal striatum is positively correlated with withdrawal aversion. Here, we examined regional differences in striatal DA function associated with opioid withdrawal in rats exposed to intermittent morphine injections for 31 days. Basal concentrations of DA were reduced (i.e., indicating a hypodopaminergic state) in the ventral striatum on Day 10 of morphine exposure, whereas a more prolonged period of morphine treatment was required to reveal hypodopaminergia in the dorsal striatum on Day 31. The ventral striatum consistently exhibited naloxone-induced transient reductions in DA below the hypodopaminergic basal levels, whereas morphine enhanced DA efflux. In the dorsal striatum, DA responsivity to naloxone shifted from a significant decrease on Day 10 to a notable increase above hypodopaminergic basal levels on Day 31, corroborating the findings in the human dorsal striatum. Unexpectedly, the magnitude of morphine-evoked increases in DA efflux on Day 31 was significantly blunted relative to values on Day 10. These findings indicate that prolonged-intermittent access to morphine results in a sustained hypodopaminergic state as reflected in basal levels in the striatum, which is accompanied by regional differences in DA responsivity to naloxone and morphine. Overall, our findings suggest that prolonging the duration of morphine exposure to 31 days is sufficient to reveal neuroadaptations that may underlie the transition from initial drug exposure to opioid dependence.
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Affiliation(s)
- Soyon Ahn
- Djavad Mowafaghian Centre for Brain Health and Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Haiyan Zou
- Djavad Mowafaghian Centre for Brain Health and Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Jeremy K Seamans
- Djavad Mowafaghian Centre for Brain Health and Department of Psychiatry, University of British Columbia, Vancouver, Canada
| | - Anthony G Phillips
- Djavad Mowafaghian Centre for Brain Health and Department of Psychiatry, University of British Columbia, Vancouver, Canada
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12
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Miller EA, DeVeaugh-Geiss AM, Chilcoat HD. Opioid use disorder (OUD) and treatment for opioid problems among OUD symptom subtypes in individuals misusing opioids. DRUG AND ALCOHOL DEPENDENCE REPORTS 2024; 10:100220. [PMID: 38414666 PMCID: PMC10897812 DOI: 10.1016/j.dadr.2024.100220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/01/2024] [Accepted: 02/09/2024] [Indexed: 02/29/2024]
Abstract
Background In 2021, approximately 60 million individuals worldwide and 9 million individuals in the United States (US) reported opioid misuse. In the US, 2.5 million have OUD, of which only about a third receive any substance abuse treatment. OUD is often regarded as a monolithic disorder but different opioid problem subtypes may exist beyond DSM-IV/5 criteria. Understanding the characteristics of these subtypes could be useful for informing treatment and intervention strategies. Methods Latent class analysis was used to identify OUD symptom subtypes among persons in the US who reported misusing prescription opioids or heroin in the 2015-2018 National Survey on Drug Use and Health (n=10,928). Regression analyses were utilized to determine associations between class membership and treatment receipt, as well as demographic characteristics and other comorbid conditions. Results Five classes were identified with unique OUD symptom patterns: Class 1: Asymptomatic (71.6%), Class 2: Tolerance/Time (14.5%), Class 3: Loss of Control/Pharmacological (LOC/Pharmacol) (5.7%), Class 4: Social Impairment (2.6%), and Class 5: Pervasive (5.6%). Nearly all persons in the LOC/Pharmacol, Social Impairment, and Pervasive classes met criteria for OUD (98-100%); however, they differed in receipt of past-year treatment for substance use (28%, 28%, 49%, respectively). Age, race, education, insurance status, and criminal activity were also associated with treatment receipt. Conclusions There were considerable differences in OUD symptom patterns and substance use treatment among individuals who misused opioids. The findings indicate a substantial unmet need for OUD treatment and point to patterns of heterogeneity within OUD that can inform development of treatment programs.
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Affiliation(s)
- Emily A. Miller
- Virginia Commonwealth University School of Pharmacy, 410 N 12th St, Richmond, VA 23298, USA
| | | | - Howard D. Chilcoat
- Indivior, Inc., 10710 Midlothian Turnpike, Suite 125, North Chesterfield, VA 23235, USA
- Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA
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13
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Rankin L, Grisham LM, Mendoza N, Allen A. Babywearing Reduces Urges to Use Substances in the Postpartum Period Among Mothers With OUDs. Subst Use Misuse 2024; 59:1150-1156. [PMID: 38404001 DOI: 10.1080/10826084.2024.2321253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
OBJECTIVES While pregnancy presents a strong motivation to seek and comply with Opioid Use Disorder (OUD) treatment, the risk for relapse during the postpartum period is high. The purpose of the present study was to examine the impact of babywearing while admitted to the NICU on urges to use substances within 9 months of childbirth. METHODS Mothers with a history of OUD (N = 47, Mage = 28.91, SD = 5.14; 48.9% White, 19.1% Latinx) and their newborns were randomly assigned to the intervention (babywearing) or control (infant rocker) condition while admitted to a NICU. Interviews occurred every 3-months. Participants reported their strong desire or urge to use substances since the last interview. Approximately 68.1% had urges within 9 months. At 3 months, participants were categorized as: never babywore (0 h, N = 18), some babywearing (1-44 h, N = 13), consistent babywearing (45+ hours, i.e., minimum of 3.5 h per week, N = 16). RESULTS Condition X2(2, N = 47)=12.55, p < 0.001, Phi = 0.52 and babywearing category, X2(2, N = 47)=6.75, p = 0.034, Phi = 0.38 significantly predicted urges to use. Mothers in the intervention condition were more likely to report no urges to use: 56.5% had no urges (43.5% had urges) compared to 8.3% of control mothers (91.7% had urges). Mothers who consistently babywore had significantly fewer urges to use (43.8% had urges) compared to mothers who never babywore (83.3% had urges). CONCLUSIONS FOR PRACTICE There is a critical window to capitalize on mothers' desire to abstain from substance use. Babywearing, and specifically babywearing at least 30 min a day, reduced urges to use substances post-partum, a factor associated with relapse.
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Affiliation(s)
- Lela Rankin
- School of Social Work Tucson, Arizona State University, Tucson, Arizona, USA
| | - Lisa M Grisham
- College of Nursing, University of Arizona, Tucson, Arizona, USA
- Department of Pediatrics, Banner University Medical Center Tucson, Tucson, Arizona, USA
| | - Natasha Mendoza
- School of Social Work Phoenix, Arizona State University, Tucson, Arizona, USA
| | - Alicia Allen
- Department of Family and Community Medicine, College of Medicine - Tucson, University of Arizona, Tucson, Arizona, USA
- Clinical Translational Sciences, University of Arizona, Tucson, Arizona, USA
- Epidemiology & Biostatistics, Mel & Enid Zuckerman College of Public Health; University of Arizona, Tucson, Arizona, USA
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14
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Montoya ID, Volkow ND. IUPHAR Review: New strategies for medications to treat substance use disorders. Pharmacol Res 2024; 200:107078. [PMID: 38246477 PMCID: PMC10922847 DOI: 10.1016/j.phrs.2024.107078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/11/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
Substance use disorders (SUDs) and drug overdose are a public health emergency and safe and effective treatments are urgently needed. Developing new medications to treat them is expensive, time-consuming, and the probability of a compound progressing to clinical trials and obtaining FDA-approval is low. The small number of FDA-approved medications for SUDs reflects the low interest of pharmaceutical companies to invest in this area due to market forces, characteristics of the population (e.g., stigma, and socio-economic and legal disadvantages), and the high bar regulatory agencies set for new medication approval. In consequence, most research on medications is funded by government agencies, such as the National Institute on Drug Abuse (NIDA). Multiple scientific opportunities are emerging that can accelerate the discovery and development of new medications for SUDs. These include fast and efficient tools to screen new molecules, discover new medication targets, use of big data to explore large clinical data sets and artificial intelligence (AI) applications to make predictions, and precision medicine tools to individualize and optimize treatments. This review provides a general description of these new research strategies for the development of medications to treat SUDs with emphasis on the gaps and scientific opportunities. It includes a brief overview of the rising public health toll of SUDs; the justification, challenges, and opportunities to develop new medications; and a discussion of medications and treatment endpoints that are being evaluated with support from NIDA.
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Affiliation(s)
- Ivan D Montoya
- Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, 3 White Flint North, North Bethesda, MD 20852, United States.
| | - Nora D Volkow
- National Institute on Drug Abuse, 3 White Flint North, North Bethesda, MD 20852, United States
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15
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Jiang C, Huang H, Yang X, Le Q, Liu X, Ma L, Wang F. Targeting mitochondrial dynamics of morphine-responsive dopaminergic neurons ameliorates opiate withdrawal. J Clin Invest 2024; 134:e171995. [PMID: 38236644 PMCID: PMC10904060 DOI: 10.1172/jci171995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 01/11/2024] [Indexed: 03/02/2024] Open
Abstract
Converging studies demonstrate the dysfunction of the dopaminergic neurons following chronic opioid administration. However, the therapeutic strategies targeting opioid-responsive dopaminergic ensembles that contribute to the development of opioid withdrawal remain to be elucidated. Here, we used the neuronal activity-dependent Tet-Off system to label dopaminergic ensembles in response to initial morphine exposure (Mor-Ens) in the ventral tegmental area (VTA). Fiber optic photometry recording and transcriptome analysis revealed downregulated spontaneous activity and dysregulated mitochondrial respiratory, ultrastructure, and oxidoreductase signal pathways after chronic morphine administration in these dopaminergic ensembles. Mitochondrial fragmentation and the decreased mitochondrial fusion gene mitofusin 1 (Mfn1) were found in these ensembles after prolonged opioid withdrawal. Restoration of Mfn1 in the dopaminergic Mor-Ens attenuated excessive oxidative stress and the development of opioid withdrawal. Administration of Mdivi-1, a mitochondrial fission inhibitor, ameliorated the mitochondrial fragmentation and maladaptation of the neuronal plasticity in these Mor-Ens, accompanied by attenuated development of opioid withdrawal after chronic morphine administration, without affecting the analgesic effect of morphine. These findings highlighted the plastic architecture of mitochondria as a potential therapeutic target for opioid analgesic-induced substance use disorders.
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Affiliation(s)
- Changyou Jiang
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science and School of Basic Medical Sciences, Departments of Neurosurgery and Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Research Unit of Addiction Memory, Chinese Academy of Medical Sciences (2021RU009), Shanghai, China
| | - Han Huang
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science and School of Basic Medical Sciences, Departments of Neurosurgery and Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Research Unit of Addiction Memory, Chinese Academy of Medical Sciences (2021RU009), Shanghai, China
| | - Xiao Yang
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science and School of Basic Medical Sciences, Departments of Neurosurgery and Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Research Unit of Addiction Memory, Chinese Academy of Medical Sciences (2021RU009), Shanghai, China
| | - Qiumin Le
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science and School of Basic Medical Sciences, Departments of Neurosurgery and Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Research Unit of Addiction Memory, Chinese Academy of Medical Sciences (2021RU009), Shanghai, China
| | - Xing Liu
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science and School of Basic Medical Sciences, Departments of Neurosurgery and Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Research Unit of Addiction Memory, Chinese Academy of Medical Sciences (2021RU009), Shanghai, China
| | - Lan Ma
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science and School of Basic Medical Sciences, Departments of Neurosurgery and Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Research Unit of Addiction Memory, Chinese Academy of Medical Sciences (2021RU009), Shanghai, China
| | - Feifei Wang
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institutes of Brain Science and School of Basic Medical Sciences, Departments of Neurosurgery and Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- Research Unit of Addiction Memory, Chinese Academy of Medical Sciences (2021RU009), Shanghai, China
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16
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Moosavyzadeh A, Ghaffari F, Saberizafarghandi MB, Talafi Noghani M, Hassanpour H, Emadi F, Alijaniha F, Bahaeddin Z, Nasiri L, Jafari Hajati R, Naseri M. Deaddicta® for maintenance treatment of Opioid-dependence: A six-month follow-up. CASPIAN JOURNAL OF INTERNAL MEDICINE 2024; 15:318-327. [PMID: 38807734 PMCID: PMC11129080 DOI: 10.22088/cjim.15.2.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/03/2023] [Accepted: 08/20/2023] [Indexed: 05/30/2024]
Abstract
Background Opioid dependence, is one of the world's most critical health problems. Deaddicta is a herbal product considered an effective treatment for opioid addiction. Deaddicta's efficacy in the maintenance treatment of patients with opioid use disorder has recently been demonstrated through a double-blind randomized controlled trial (RCT). This study aimed to evaluate the permanence of Deaddicta's efficacy six months after the end of the maintenance treatment for opioid dependence. Methods This study was performed following the previous RCT on the maintenance treatment of opioid addicts. Out of 41 participants who completed the study for three months in the previous research, 15 from the intervention group (Deaddicta capsules, 1500 mg/day) returned for follow-up. They all previously fulfilled the DSM-IV criteria for addiction, were aged 18 to 65, and had discontinued Deaddicta for six months. The outcome measures included addiction severity, depression and anxiety levels, and craving score. The scores of each parameter were compared in three phases: before intervention; after three months of intervention; and six months after the end of the study. Results Depression, anxiety, and craving scores decreased six months after the end of the previous study. This decrease was significant in the craving score (P = 0.011). No significant increase was observed in the frequency of use. The regression analysis showed a negative relationship between craving and the progression of phases. Conclusion The Deaddicta product may have desirable and effective properties in decreasing temptation and, as a result, the maintenance treatment of opioid dependence.
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Affiliation(s)
- Abdolali Moosavyzadeh
- Department of Persian Medicine, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
- Traditional Medicine Clinical Trial Research Center, Shahed University, Tehran, Iran
| | - Farzaneh Ghaffari
- School of Traditional Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Bagher Saberizafarghandi
- Department of Addiction, School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Talafi Noghani
- Traditional Medicine Clinical Trial Research Center, Shahed University, Tehran, Iran
- Department of Traditional Medicine, School of Persian Medicine, Shahed University, Tehran, Iran
| | - Hossein Hassanpour
- Traditional Medicine Clinical Trial Research Center, Shahed University, Tehran, Iran
- Department of Basic Sciences, Faculty of Veterinary Medicine, Shahrekord University, Shahrekord, Iran
| | - Fatemeh Emadi
- Traditional Medicine Clinical Trial Research Center, Shahed University, Tehran, Iran
- Department of Traditional Medicine, School of Persian Medicine, Shahed University, Tehran, Iran
| | - Fatemeh Alijaniha
- Traditional Medicine Clinical Trial Research Center, Shahed University, Tehran, Iran
| | - Zahra Bahaeddin
- Traditional Medicine Clinical Trial Research Center, Shahed University, Tehran, Iran
| | - Leila Nasiri
- Traditional Medicine Clinical Trial Research Center, Shahed University, Tehran, Iran
- Department of Health Equity, Immunoregulation Research Center, Shahed University, Tehran, Iran
| | - Razieh Jafari Hajati
- Traditional Medicine Clinical Trial Research Center, Shahed University, Tehran, Iran
| | - Mohsen Naseri
- Traditional Medicine Clinical Trial Research Center, Shahed University, Tehran, Iran
- Department of Traditional Medicine, School of Persian Medicine, Shahed University, Tehran, Iran
- Hikmat, Islamic and Traditional Medicine Department, The Academy of Medical Sciences, Tehran, Iran
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17
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Yang Y. Modeling state- and trait-level associations between aggression, somatic symptoms, substance use, and distress tolerance. Aggress Behav 2023; 49:580-594. [PMID: 37390384 DOI: 10.1002/ab.22096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/23/2023] [Accepted: 06/14/2023] [Indexed: 07/02/2023]
Abstract
The current study examined the state- and trait-level associations of psychological and physical aggression to somatic symptoms, and alcohol and drug use and tested the influence of distress tolerance on these associations, while controlling for stress, sex, and minority status. A naturalistic observation was used to collect data with a sample of 245 college students at three time points with 2 weeks apart. Random-intercept cross-lagged panel models were used to disaggregate within-person effects (autoregressive and cross-lagged effects) from the between-person (latent trait-level) associations. The findings revealed that there were autoregressive effects of psychological aggression between Time 1 (T1) and Time 2 (T2) and of physical aggression between T1 and T2. There was a bidirectional association between psychological aggression and somatic symptoms at T2 and Time 3 (T3), in which T2 psychological aggression predicted T3 somatic symptoms and verse vera. T1 drug use predicted T2 physical aggression, which in turn predicted T3 somatic symptoms, indicating physical aggression being a mediator between earlier drug use and later somatic symptoms. Distress tolerance was negatively associated with psychological aggression and somatic symptoms, respectively, and such an influence did not differ across time occasions. The findings indicated the importance of incorporating physical health in the prevention and intervention of psychological aggression. Clinicians may also consider including psychological aggression in the screening of somatic symptoms or physical health. Empirical-supported therapy components for enhancing distress tolerance may help mitigate psychological aggression and somatic symptoms.
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Affiliation(s)
- Yang Yang
- Institute of Behavioral Research, Texas Christian University, Fort Worth, Texas, USA
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18
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Barrett JE, Shekarabi A, Inan S. Oxycodone: A Current Perspective on Its Pharmacology, Abuse, and Pharmacotherapeutic Developments. Pharmacol Rev 2023; 75:1062-1118. [PMID: 37321860 PMCID: PMC10595024 DOI: 10.1124/pharmrev.121.000506] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 04/30/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023] Open
Abstract
Oxycodone, a semisynthetic derivative of naturally occurring thebaine, an opioid alkaloid, has been available for more than 100 years. Although thebaine cannot be used therapeutically due to the occurrence of convulsions at higher doses, it has been converted to a number of other widely used compounds that include naloxone, naltrexone, buprenorphine, and oxycodone. Despite the early identification of oxycodone, it was not until the 1990s that clinical studies began to explore its analgesic efficacy. These studies were followed by the pursuit of several preclinical studies to examine the analgesic effects and abuse liability of oxycodone in laboratory animals and the subjective effects in human volunteers. For a number of years oxycodone was at the forefront of the opioid crisis, playing a significant role in contributing to opioid misuse and abuse, with suggestions that it led to transitioning to other opioids. Several concerns were expressed as early as the 1940s that oxycodone had significant abuse potential similar to heroin and morphine. Both animal and human abuse liability studies have confirmed, and in some cases amplified, these early warnings. Despite sharing a similar structure with morphine and pharmacological actions also mediated by the μ-opioid receptor, there are several differences in the pharmacology and neurobiology of oxycodone. The data that have emerged from the many efforts to analyze the pharmacological and molecular mechanism of oxycodone have generated considerable insight into its many actions, reviewed here, which, in turn, have provided new information on opioid receptor pharmacology. SIGNIFICANCE STATEMENT: Oxycodone, a μ-opioid receptor agonist, was synthesized in 1916 and introduced into clinical use in Germany in 1917. It has been studied extensively as a therapeutic analgesic for acute and chronic neuropathic pain as an alternative to morphine. Oxycodone emerged as a drug with widespread abuse. This article brings together an integrated, detailed review of the pharmacology of oxycodone, preclinical and clinical studies of pain and abuse, and recent advances to identify potential opioid analgesics without abuse liability.
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Affiliation(s)
- James E Barrett
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University. Philadelphia, Pennsylvania
| | - Aryan Shekarabi
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University. Philadelphia, Pennsylvania
| | - Saadet Inan
- Center for Substance Abuse Research, Lewis Katz School of Medicine, Temple University. Philadelphia, Pennsylvania
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19
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Li X, Langleben DD, Lynch KG, Wang GJ, Elman I, Wiers CE, Shi Z. Association between body mass index and treatment completion in extended-release naltrexone-treated patients with opioid dependence. Front Psychiatry 2023; 14:1247961. [PMID: 37599869 PMCID: PMC10433165 DOI: 10.3389/fpsyt.2023.1247961] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Background Excessive consumption of opioids is associated with impaired metabolic function including increased body mass index (BMI). Opioid antagonist naltrexone (NTX) is an effective treatment for opioid use disorder (OUD) that has the potential to mitigate such metabolic disturbances. Understanding the relationship between treatment adherence and BMI in NTX-treated OUD patients may provide valuable insights into optimizing clinical outcomes. Methods Patients with opioid dependence were offered up to three monthly injections of extended-release (XR) NTX. Treatment completers (n = 41) were defined as those who had received all three XR-NTX injections, and non-completers (n = 20) as those missing at least one injection. Logistic regression was performed to examine the association between pre-treatment BMI and treatment completion. Results BMI was positively associated with treatment completion. This association remained significant after adjusting for potentially confounding variables. Conclusion Our findings suggest that baseline BMI may serve as a potential predictor of XR-NTX treatment adherence in patients with OUD and could help healthcare providers and policy makers alike in developing strategies to improve retention and tailor interventions for specific patient subgroups.
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Affiliation(s)
- Xinyi Li
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Daniel D. Langleben
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Kevin G. Lynch
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Gene-Jack Wang
- National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD, United States
| | - Igor Elman
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Boston, MA, United States
| | - Corinde E. Wiers
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Zhenhao Shi
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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20
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Pollard AA, Hauson AO, Lackey NS, Zhang E, Khayat S, Carson B, Fortea L, Radua J, Grant I. Functional neuroanatomy of craving in heroin use disorder: voxel-based meta-analysis of functional magnetic resonance imaging (fMRI) drug cue reactivity studies. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:418-430. [PMID: 36880845 DOI: 10.1080/00952990.2023.2172423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 03/08/2023]
Abstract
Background: The neuroanatomy of craving, typically investigated using the functional magnetic resonance imaging (fMRI) drug cue reactivity (FDCR) paradigm, has been shown to involve the mesocorticolimbic, nigrostriatal, and corticocerebellar systems in several substances. However, the neuroanatomy of craving in heroin use disorder is still unclear.Objective: The current meta-analysis examines previous research on the neuroanatomy of craving in abstinent individuals with opioid use disorder (OUD).Method: Seven databases were searched for studies comparing abstinent OUD versus healthy controls on drug > neutral contrast interaction at the whole-brain level. Voxel-based meta-analysis was performed using seed-based d mapping with permuted subject images (SDM-PSI). Thresholds were set at a family-wise error rate of less than 5% with the default pre-processing parameters of SDM-PSI.Results: A total of 10 studies were included (296 OUD and 187 controls). Four hyperactivated clusters were identified with Hedges' g of peaks that ranged from 0.51 to 0.82. These peaks and their associated clusters correspond to the three systems identified in the previous literature: a) mesocorticolimbic, b) nigrostriatal, and c) corticocerebellar. There were also newly revealed hyperactivation regions including the bilateral cingulate, precuneus, fusiform gyrus, pons, lingual gyrus, and inferior occipital gyrus. The meta-analysis did not reveal areas of hypoactivation.Conclusion: Recommendations based on the functional neuroanatomical findings of this meta-analysis include pharmacological interventions such as buprenorphine/naloxone and cognitive-behavioral treatments such as cue-exposure combined with HRV biofeedback. In addition, research should utilize FDCR as pre- and post-measurement to determine the effectiveness and mechanism of action of such interventions.
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Affiliation(s)
- Anna A Pollard
- California School of Professional Psychology, Clinical Psychology PhD Program, San Diego, CA, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINS.org), San Diego, CA, USA
| | - Alexander O Hauson
- California School of Professional Psychology, Clinical Psychology PhD Program, San Diego, CA, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINS.org), San Diego, CA, USA
- Department of Psychiatry, University of San Diego, La Jolla, CA, USA
| | - Nicholas S Lackey
- California School of Professional Psychology, Clinical Psychology PhD Program, San Diego, CA, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINS.org), San Diego, CA, USA
| | - Emily Zhang
- California School of Professional Psychology, Clinical Psychology PhD Program, San Diego, CA, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINS.org), San Diego, CA, USA
| | - Sarah Khayat
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINS.org), San Diego, CA, USA
| | - Bryce Carson
- California School of Professional Psychology, Clinical Psychology PhD Program, San Diego, CA, USA
- Institute of Brain Research and Integrated Neuropsychological Services (iBRAINS.org), San Diego, CA, USA
| | - Lydia Fortea
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Department of Psychosis Studies, Institute of Psychology, Psychiatry, and Neuroscience, King's College London, London, UK
| | - Igor Grant
- Department of Psychiatry, University of San Diego, La Jolla, CA, USA
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Tabanelli R, Brogi S, Calderone V. Targeting Opioid Receptors in Addiction and Drug Withdrawal: Where Are We Going? Int J Mol Sci 2023; 24:10888. [PMID: 37446064 DOI: 10.3390/ijms241310888] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/14/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
This review article offers an outlook on the use of opioids as therapeutics for treating several diseases, including cancer and non-cancer pain, and focuses the analysis on the opportunity to target opioid receptors for treating opioid use disorder (OUD), drug withdrawal, and addiction. Unfortunately, as has been well established, the use of opioids presents a plethora of side effects, such as tolerance and physical and physiological dependence. Accordingly, considering the great pharmacological potential in targeting opioid receptors, the identification of opioid receptor ligands devoid of most of the adverse effects exhibited by current therapeutic agents is highly necessary. To this end, herein, we analyze some interesting molecules that could potentially be useful for treating OUD, with an in-depth analysis regarding in vivo studies and clinical trials.
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Affiliation(s)
- Rita Tabanelli
- Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy
| | - Simone Brogi
- Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy
| | - Vincenzo Calderone
- Department of Pharmacy, University of Pisa, Via Bonanno 6, 56126 Pisa, Italy
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22
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Liu HM, Liao ML, Liu GX, Wang LJ, Lian D, Ren J, Chi XT, Lv ZR, Liu M, Wu Y, Xu T, Wei JY, Feng X, Jiang B, Zhang XQ, Xin WJ. IPAC integrates rewarding and environmental memory during the acquisition of morphine CPP. SCIENCE ADVANCES 2023; 9:eadg5849. [PMID: 37352353 PMCID: PMC10289658 DOI: 10.1126/sciadv.adg5849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/22/2023] [Indexed: 06/25/2023]
Abstract
The association between rewarding and drug-related memory is a leading factor for the formation of addiction, yet the neural circuits underlying the association remain unclear. Here, we showed that the interstitial nucleus of the posterior limb of the anterior commissure (IPAC) integrated rewarding and environmental memory information by two different receiving projections from ventral tegmental area (VTA) and nucleus accumbens shell region (NAcSh) to mediate the acquisition of morphine conditioned place preference (CPP). A projection from the VTA GABAergic neurons (VTAGABA) to the IPAC lateral region GABAergic neurons (IPACLGABA) mediated the effect of morphine rewarding, whereas the pathway from NAcSh dopamine receptor 1-expressing neurons (NAcShD1) to the IPAC medial region GABAergic neurons (IPACMGABA) was involved in the acquisition of environmental memory. These findings demonstrated that the distinct IPAC circuits VTAGABA→IPACLGABA and NAcShD1R→IPACMGABA were attributable to the rewarding and environmental memory during the acquisition of morphine CPP, respectively, and provided the circuit-based potential targets for preventing and treating opioid addiction.
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Affiliation(s)
- Huan-Min Liu
- The Institute of Mental Psychology, School of Health Management, The Affiliated Brain Hospital (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou 510370, China
| | - Ming-Lu Liao
- The Institute of Mental Psychology, School of Health Management, The Affiliated Brain Hospital (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou 510370, China
| | - Guan-Xi Liu
- The Institute of Mental Psychology, School of Health Management, The Affiliated Brain Hospital (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou 510370, China
| | - Lai-Jian Wang
- Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan Medical School, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou 510080, China
| | - Dian Lian
- The Institute of Mental Psychology, School of Health Management, The Affiliated Brain Hospital (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou 510370, China
| | - Jie Ren
- The Institute of Mental Psychology, School of Health Management, The Affiliated Brain Hospital (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou 510370, China
| | - Xin-Tian Chi
- The Institute of Mental Psychology, School of Health Management, The Affiliated Brain Hospital (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou 510370, China
| | - Zhuo-Ran Lv
- The Institute of Mental Psychology, School of Health Management, The Affiliated Brain Hospital (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou 510370, China
| | - Meng Liu
- Department of Anesthesia and Pain Medicine, Guangzhou First People’s Hospital, Guangzhou 510000, China
| | - Yan Wu
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Ting Xu
- Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan Medical School, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou 510080, China
| | - Jia-You Wei
- Neuroscience Program, Zhongshan School of Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China
| | - Xia Feng
- Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
| | - Bin Jiang
- Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan Medical School, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou 510080, China
| | - Xue-Qin Zhang
- The Institute of Mental Psychology, School of Health Management, The Affiliated Brain Hospital (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou 510370, China
| | - Wen-Jun Xin
- Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan Medical School, Sun Yat-sen University, 74 Zhongshan Road 2, Guangzhou 510080, China
- Neuroscience Program, Zhongshan School of Medicine, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai 519000, China
- Guangdong Province Key Laboratory of Brain Function and Disease, Department of Physiology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou 510080, China
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23
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Zeng J, You L, Yang F, Luo Y, Yu S, Yan J, Liu M, Yang X. A meta-analysis of the neural substrates of monetary reward anticipation and outcome in alcohol use disorder. Hum Brain Mapp 2023; 44:2841-2861. [PMID: 36852619 PMCID: PMC10089105 DOI: 10.1002/hbm.26249] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 01/23/2023] [Accepted: 02/13/2023] [Indexed: 03/01/2023] Open
Abstract
The capacity to anticipate and detect rewarding outcomes is fundamental for the development of adaptive decision-making and goal-oriented behavior. Delineating the neural correlates of different stages of reward processing is imperative for understanding the neurobiological mechanism underlying alcohol use disorder (AUD). To examine the neural correlates of monetary anticipation and outcome in AUD patients, we performed two separate voxel-wise meta-analyses of functional neuroimaging studies, including 12 studies investigating reward anticipation and 7 studies investigating reward outcome using the monetary incentive delay task. During the anticipation stage, AUD patients displayed decreased activation in response to monetary cues in mesocortical-limbic circuits and sensory areas, including the ventral striatum (VS), insula, hippocampus, inferior occipital gyrus, supramarginal gyrus, lingual gyrus and fusiform gyrus. During the outcome stage, AUD patients exhibited reduced activation in the dorsal striatum, VS and insula, and increased activation in the orbital frontal cortex and medial temporal area. Our findings suggest that different activation patterns are associated with nondrug rewards during different reward processing stages, potentially reflecting a changed sensitivity to monetary reward in AUD.
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Affiliation(s)
- Jianguang Zeng
- School of Economics and Business AdministrationChongqing UniversityChongqingChina
| | - Lantao You
- School of Economics and Business AdministrationChongqing UniversityChongqingChina
| | - Fan Yang
- Department of Ultrasonography, West China Second University HospitalSichuan UniversityChengduChina
- Chengdu Chenghua District Maternal and Child Health HospitalSichuan UniversityChengduChina
| | - Ya Luo
- Department of Psychiatry, State Key Lab of BiotherapyWest China Hospital of Sichuan UniversityChengduChina
| | - Shuxian Yu
- School of Economics and Business AdministrationChongqing UniversityChongqingChina
| | - Jiangnan Yan
- School of Economics and Business AdministrationChongqing UniversityChongqingChina
| | - Mengqi Liu
- Department of RadiologyThe First Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Xun Yang
- School of Public AffairsChongqing UniversityChongqingChina
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24
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Yücel SG, Higgins CD, Gupta K, Palm M. Public transport access to drug treatment before and during COVID-19: Implications for the opioid epidemic. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 116:104032. [PMID: 37172439 PMCID: PMC10130333 DOI: 10.1016/j.drugpo.2023.104032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 04/12/2023] [Accepted: 04/15/2023] [Indexed: 05/15/2023]
Abstract
Public transport disruptions caused by the COVID-19 pandemic had wide-ranging impacts on the ability of individuals to access health care. Individuals with opioid use disorder represent an especially vulnerable population due to the necessity of frequent, supervised doses of opioid agonists. Focused on Toronto, a major Canadian city suffering from the opioid epidemic, this analysis uses novel realistic routing methodologies to quantify how travel times to individuals\220 nearest clinics changed due to public transport disruptions from 2019 to 2020. Individuals seeking opioid agonist treatment face very constrained windows of access due to the need to manage work and other essential activities. We find that thousands of households in the most materially and socially deprived neighbourhoods crossed 30 and 20-minute travel time thresholds to their nearest clinic. As even small changes to travel times can lead to missed appointments and heighten the chances of overdose and death, understanding the distribution of those most impacted can help inform future policy measures to ensure adequate access to care.
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Affiliation(s)
- Shiv Gazi Yücel
- Transport Studies Unit, School of Geography and the Environment, University of Oxford, Oxford, United Kingdom.
| | | | - Kumar Gupta
- Office of the Chief Coroner of Ontario, Canada
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25
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Alvarez-Perez B, Poras H, Maldonado R. The inhibition of enkephalin catabolism by dual enkephalinase inhibitor: A novel possible therapeutic approach for opioid use disorders. Br J Pharmacol 2023; 180:879-893. [PMID: 34378790 DOI: 10.1111/bph.15656] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/14/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022] Open
Abstract
Despite the increasing impact of opioid use disorders on society, there is a disturbing lack of effective medications for their clinical management. An interesting innovative strategy to treat these disorders consists in the protection of endogenous opioid peptides to activate opioid receptors, avoiding the classical opioid-like side effects. Dual enkephalinase inhibitors (DENKIs) physiologically activate the endogenous opioid system by inhibiting the enzymes responsible for the breakdown of enkephalins, protecting endogenous enkephalins and increasing their half-lives and physiological actions. The activation of opioid receptors by the increased enkephalin levels, and their well-demonstrated safety, suggests that DENKIs could represent a novel analgesic therapy and a possible effective treatment for acute opioid withdrawal, as well as a promising alternative to opioid substitution therapy minimizing side effects. This new pharmacological class of compounds could bring effective and safe medications avoiding the major limitations of exogenous opioids, representing a novel approach to overcome the problem of opioid use disorders. LINKED ARTICLES: This article is part of a themed issue on Advances in Opioid Pharmacology at the Time of the Opioid Epidemic. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v180.7/issuetoc.
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Affiliation(s)
- Beltran Alvarez-Perez
- Laboratory of Neuropharmacology, Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | | | - Rafael Maldonado
- Laboratory of Neuropharmacology, Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
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26
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Elkrief L, Bastien G, McAnulty C, Bakouni H, Hébert FO, Socias ME, Le Foll B, Lim R, Ledjiar O, Marsan S, Brissette S, Jutras-Aswad D. Differential effect of cannabis use on opioid agonist treatment outcomes: Exploratory analyses from the OPTIMA study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 149:209031. [PMID: 37003540 DOI: 10.1016/j.josat.2023.209031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/09/2022] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
INTRODUCTION Conflictual evidence exists regarding the effects of cannabis use on the outcomes of opioid agonist therapy (OAT). In this exploratory analysis, we examined the effect of recent cannabis use on opioid use, craving, and withdrawal symptoms, in individuals participating in a trial comparing flexible buprenorphine/naloxone (BUP/NX) take-home dosing model to witnessed ingestion of methadone. METHODS We analyzed data from a multi-centric, pragmatic, 24-week, open label, randomized controlled trial in individuals with prescription-type opioid use disorder (n = 272), randomly assigned to BUP/NX (n = 138) or methadone (n = 134). The study measured last week cannabis and opioid use via timeline-follow back, recorded at baseline and every two weeks during the study. Craving symptoms were measured using the Brief Substance Craving Scale at baseline, and weeks 2, 6, 10, 14, 18 and 22. The study measured opioid withdrawal symptoms via Clinical Opiate Withdrawal Scale at treatment initiation and weeks 2, 4, and 6. RESULTS The mean maximum dose taken during the study was 17.3 mg/day (range = 0.5-32 mg/day) for BUP/NX group and 67.7 mg/day (range = 10-170 mg/day) in the methadone group. Repeated measures generalized linear mixed models demonstrated that cannabis use in the last week (mean of 2.3 days) was not significantly associated with last week opioid use (aβ ± standard error (SE) = -0.06 ± 0.04; p = 0.15), craving (aβ ± SE = -0.05 ± 0.08, p = 0.49), or withdrawal symptoms (aβ ± SE = 0.09 ± 0.1, p = 0.36). Bayes factor (BF) for each of the tested models supported the null hypothesis (BF < 0.3). CONCLUSIONS The current study did not demonstrate a statistically significant effect of cannabis use on outcomes of interest in the context of a pragmatic randomized-controlled trial. These findings replicated previous results reporting no effect of cannabis use on opioid-related outcomes.
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Affiliation(s)
- Laurent Elkrief
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada
| | - Gabriel Bastien
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada
| | - Christina McAnulty
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada
| | - Hamzah Bakouni
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada
| | - François-Olivier Hébert
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada
| | - M Eugenia Socias
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, British Columbia V6Z 2A9, Canada; Department of Medicine, Faculty of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, British Columbia V5Z 1M9, Canada
| | - Bernard Le Foll
- Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health (CAMH), 33 Ursula Franklin Street, Toronto, Ontario M5S 2S1, Canada; Department of Pharmacology and Toxicology, Faculty of Medicine, Medical Sciences Building, University of Toronto, 1 King's College Circle, Toronto, Ontario M5S 1A8, Canada; Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, 500 University Avenue, 5th floor, Toronto, Ontario M5G 1V7, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, Ontario M5T 1R8, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 3M7, Canada; Waypoint Research Institute, Waypoint Centre for Mental Health Care, 500 Church Street, Penetanguishene, Ontario L9M 1G3, Canada
| | - Ron Lim
- Department of Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Omar Ledjiar
- Unité de recherche clinique appliquée, Centre hospitalier universitaire Ste-Justine, 3175 chemin de la Côte Ste-Catherine, Montréal, Québec H3T 1C5, Canada
| | - Stéphanie Marsan
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada
| | - Suzanne Brissette
- Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada
| | - Didier Jutras-Aswad
- Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, 2900 boul. Edouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Research Centre, Centre Hospitalier de l'Université de Montréal (CRCHUM), 900 Saint-Denis Street, Montréal, Québec H2X 0A9, Canada.
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Suzuki J, Prostko S, Szpak V, Chai PR, Spagnolo PA, Tenenbaum RE, Ahmed S, Weiss RD. Impact of cannabidiol on reward- and stress-related neurocognitive processes among individuals with opioid use disorder: A pilot, double-blind, placebo-controlled, randomized cross-over trial. Front Psychiatry 2023; 14:1155984. [PMID: 37065899 PMCID: PMC10098189 DOI: 10.3389/fpsyt.2023.1155984] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/10/2023] [Indexed: 04/18/2023] Open
Abstract
Introduction Opioid use disorder (OUD) continues to be a significant public health concern. Medications for OUD (MOUD) such as buprenorphine reduce overdose mortality, but relapses occur often, leading to adverse outcomes. Preliminary data suggest that cannabidiol (CBD) may be a potential adjunctive treatment to MOUD by attenuating cue-reactivity. This pilot study sought to evaluate the impact of a single dose of CBD on reward- and stress-related neurocognitive processes implicated in relapse among those with OUD. Methods The study was a pilot, double-blind, placebo-controlled, randomized cross-over trial aimed at assessing the effects of a single dose of CBD (Epidiolex®) 600 mg or matching placebo administered to participants with OUD receiving either buprenorphine or methadone. Vital signs, mood states, pain, opioid withdrawal, cue-induced craving, attentional bias, decision-making, delayed discount, distress tolerance, and stress-reactivity were examined at each testing session on two separate testing days at least 1 week apart. Results Ten participants completed all study procedures. Receipt of CBD was associated with a significant decrease in cue-induced craving (0.2 vs. 1.3, p = 0.040), as well as reduced attentional bias toward drug-related cues as measured by the visual probe task (-80.4 vs. 100.3, p = 0.041). No differences were found among all the other outcomes examined. Discussion CBD may have promise as an adjunct to MOUD treatment by attenuating the brain response to drug-related cues, which, in turn, may reduce the risk of relapse and overdoses. Further research is warranted to evaluate the potential for CBD as an adjunctive therapy for individuals in treatment for OUD. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT04982029.
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Affiliation(s)
- Joji Suzuki
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Sara Prostko
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, United States
| | - Veronica Szpak
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, United States
| | - Peter R. Chai
- Harvard Medical School, Boston, MA, United States
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, United States
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, United States
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, United States
- The Fenway Institute, Boston, MA, United States
| | - Primavera A. Spagnolo
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | | | - Saeed Ahmed
- Rutland Regional Medical Center, Rutland, VT, United States
| | - Roger D. Weiss
- Harvard Medical School, Boston, MA, United States
- Division of Alcohol, Drugs, and Addiction, McLean Hospital, Belmont, MA, United States
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28
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Wang Y, Hou X, Wei S, Yan J, Chen Z, Zhang M, Zhang Q, Lu Y, Zhang Q, Zheng T, Jia J, Dong B, Li Y, Zhang Y, Liang J, Li G. The roles of ubiquitin-proteasome system and regulator of G protein signaling 4 in behavioral sensitization induced by a single morphine exposure. Brain Behav 2023; 13:e2922. [PMID: 36793204 PMCID: PMC10013946 DOI: 10.1002/brb3.2922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/23/2022] [Accepted: 02/04/2023] [Indexed: 02/17/2023] Open
Abstract
AIMS Opioid addiction is a major public health issue, yet its underlying mechanism is still unknown. The aim of this study was to explore the roles of ubiquitin-proteasome system (UPS) and regulator of G protein signaling 4 (RGS4) in morphine-induced behavioral sensitization, a well-recognized animal model of opioid addiction. METHODS We explored the characteristics of RGS4 protein expression and polyubiquitination in the development of behavioral sensitization induced by a single morphine exposure in rats, and the effect of a selective proteasome inhibitor, lactacystin (LAC), on behavioral sensitization. RESULTS Polyubiquitination expression was increased in time-dependent and dose-related fashions during the development of behavioral sensitization, while RGS4 protein expression was not significantly changed during this phase. Stereotaxic administration of LAC into nucleus accumbens (NAc) core inhibited the establishment of behavioral sensitization. CONCLUSION UPS in NAc core is positively involved in behavioral sensitization induced by a single morphine exposure in rats. Polyubiquitination was observed during the development phase of behavioral sensitization, while RGS4 protein expression was not significantly changed, indicating that other members of RGS family might be substrate proteins in UPS-mediated behavioral sensitization.
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Affiliation(s)
- Yanting Wang
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xingzi Hou
- State Key Laboratory of Natural and Biomimetic Drugs and Department of Natural Medicines, School of Pharmaceutical SciencesPeking University Health Science CenterBeijingChina
| | - Shoupeng Wei
- Laboratory for Integrative Neuroscience, National Institute on Alcohol Abuse and AlcoholismNational Institutes of HealthBethesdaMarylandUSA
| | - Jiaqing Yan
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zhe Chen
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Mingyu Zhang
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Qingying Zhang
- State Key Laboratory of Natural and Biomimetic Drugs and Department of Natural Medicines, School of Pharmaceutical SciencesPeking University Health Science CenterBeijingChina
| | - Yingyuan Lu
- State Key Laboratory of Natural and Biomimetic Drugs and Department of Natural Medicines, School of Pharmaceutical SciencesPeking University Health Science CenterBeijingChina
| | - Qingjie Zhang
- Department of Molecular and Cellular Pharmacology, School of Pharmaceutical SciencesPeking UniversityBeijingChina
| | - Tiange Zheng
- Department of Molecular and Cellular Pharmacology, School of Pharmaceutical SciencesPeking UniversityBeijingChina
| | - Jingyi Jia
- Department of Molecular and Cellular Pharmacology, School of Pharmaceutical SciencesPeking UniversityBeijingChina
| | - Bin Dong
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Ying Li
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yuanyuan Zhang
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Jianhui Liang
- Department of Molecular and Cellular Pharmacology, School of Pharmaceutical SciencesPeking UniversityBeijingChina
| | - Guohui Li
- Department of Pharmacy, National Cancer Center/National Clinical Research Center for Cancer/Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
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Emotional Dysregulation and Craving in Patients with Substance Use Disorder: the Mediating Role of Psychological Distress. Int J Ment Health Addict 2023. [DOI: 10.1007/s11469-023-01031-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
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Lu L, Yang W, Zhao D, Wen X, Liu J, Liu J, Yuan K. Brain recovery of the NAc fibers and prediction of craving changes in person with heroin addiction: A longitudinal study. Drug Alcohol Depend 2023; 243:109749. [PMID: 36565569 DOI: 10.1016/j.drugalcdep.2022.109749] [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: 08/17/2022] [Revised: 11/14/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Progress have been made in brain function recovery after long-term abstinence in person with heroin addiction (PHA). However, less is known about whether the nucleus accumbens (NAc) white matter pathways can recover in PHA by prolonged abstinence. METHODS Forty-two PHA and Thirty-nine age- and gender- matched healthy controls (HCs) were recruited. Two MRI scans were obtained at baseline (PHA1) and 8-month follow-up (PHA2). We employed tractography atlas-based analysis (TABS) method to investigate fractional anisotropy (FA) changes in NAc fiber tracts (i.e., Insula-NAc, ventral tegmental area (VTA)-NAc, medial prefrontal cortex (MPFC)-NAc) in PHA. A partial least square regression (PLSR) analysis was carried to explore whether FA of NAc fiber tracts can predict longitudinal craving changes. RESULTS Relative to HCs, lower FA was found in the right Insula-NAc and VTA-NAc fiber tracts in PHA1, and PHA2 showed increased FA values in these tracts compared with PHA1. Furthermore, changes of FA of NAc fiber tracts can predict longitudinal craving changes (r = 0.51). Additionally, craving changes can also be predicted from FA changes in the left Insula-NAc (r = 0.601) and VTA-NAc (r = 0.384) fiber alone. CONCLUSIONS Results indicated that the right Insula-NAc and VTA-NAc fiber tracts are potential biomarkers for brain recovery. Prediction of craving changes highlighted the utility of structural markers to inform clinical decision-making of treatment for PHA.
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Affiliation(s)
- Ling Lu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China; Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, Xi'an, Shaanxi, 710071, China
| | - Wenhan Yang
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China
| | - Desheng Zhao
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China; Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, Xi'an, Shaanxi, 710071, China
| | - Xinwen Wen
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China; Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, Xi'an, Shaanxi, 710071, China
| | - Jun Liu
- Department of Radiology, Second Xiangya Hospital of Central South University, Changsha, China.
| | - Jixin Liu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China; Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, Xi'an, Shaanxi, 710071, China.
| | - Kai Yuan
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China; Engineering Research Center of Molecular and Neuro Imaging Ministry of Education, Xi'an, Shaanxi, 710071, China; International Joint Research Center for Advanced Medical Imaging and Intelligent Diagnosis and Treatment & Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information, School of Life Science and Technology, Xidian University, Xi'an, Shaanxi 710126, China; Information Processing Laboratory, School of Information Engineering, Inner Mongolia University of Science and Technology, Baotou, Inner Mongolia, 014010, China.
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Newman AH, Xi ZX, Heidbreder C. Current Perspectives on Selective Dopamine D 3 Receptor Antagonists/Partial Agonists as Pharmacotherapeutics for Opioid and Psychostimulant Use Disorders. Curr Top Behav Neurosci 2023; 60:157-201. [PMID: 35543868 PMCID: PMC9652482 DOI: 10.1007/7854_2022_347] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Over three decades of evidence indicate that dopamine (DA) D3 receptors (D3R) are involved in the control of drug-seeking behavior and may play an important role in the pathophysiology of substance use disorders (SUD). The expectation that a selective D3R antagonist/partial agonist would be efficacious for the treatment of SUD is based on the following key observations. First, D3R are distributed in strategic areas belonging to the mesolimbic DA system such as the ventral striatum, midbrain, and ventral pallidum, which have been associated with behaviors controlled by the presentation of drug-associated cues. Second, repeated exposure to drugs of abuse produces neuroadaptations in the D3R system. Third, the synthesis and characterization of highly potent and selective D3R antagonists/partial agonists have further strengthened the role of the D3R in SUD. Based on extensive preclinical and preliminary clinical evidence, the D3R shows promise as a target for the development of pharmacotherapies for SUD as reflected by their potential to (1) regulate the motivation to self-administer drugs and (2) disrupt the responsiveness to drug-associated stimuli that play a key role in reinstatement of drug-seeking behavior triggered by re-exposure to the drug itself, drug-associated environmental cues, or stress. The availability of PET ligands to assess clinically relevant receptor occupancy by selective D3R antagonists/partial agonists, the definition of reliable dosing, and the prospect of using human laboratory models may further guide the design of clinical proof of concept studies. Pivotal clinical trials for more rapid progression of this target toward regulatory approval are urgently required. Finally, the discovery that highly selective D3R antagonists, such as R-VK4-116 and R-VK4-40, do not adversely affect peripheral biometrics or cardiovascular effects alone or in the presence of oxycodone or cocaine suggests that this class of drugs has great potential in safely treating psychostimulant and/or opioid use disorders.
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Affiliation(s)
- Amy Hauck Newman
- Medicinal Chemistry Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse-Intramural Research Program, Baltimore, MD, USA.
| | - Zheng-Xiong Xi
- Medicinal Chemistry Section, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse-Intramural Research Program, Baltimore, MD, USA
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Sirvent-Ruiz CM, Moral-Jiménez MDLV, Herrero J, Miranda-Rovés M, Rodríguez Díaz FJ. Concept of Affective Dependence and Validation of an Affective Dependence Scale. Psychol Res Behav Manag 2022; 15:3875-3888. [PMID: 36605173 PMCID: PMC9809362 DOI: 10.2147/prbm.s385807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 12/07/2022] [Indexed: 12/30/2022] Open
Abstract
Background There is a degree of affective interdependence that is considered normal and only becomes pathological if it causes excessive suffering, both for the subject and for those close to them. Our objective was to introduce and psychometrically validate a short and effective affective dependency scale, the Affective Dependence Scale (ADS-9). Methods We used a sample of 762 participants (clinical: emotional dependent subjects n = 212, comparison: non-emotionally-dependent addicted subjects n = 272, and general population n = 278) to assess the factor structure, the psychological construct validity and the measurement invariance for the ADS-9 by means of independent exploratory factor analyses for each sample group and subsequent multigroup confirmatory factor analyses. Results Our results confirm that ADS-9 is a psychometrically consistent instrument, with construct and clinical validity, as well as configural, metric and scalar invariance across different sample groups (clinical, comparison and general population). A hypothesized two-dimensional structure was confirmed by means of factor analyses. Both sub-scales of this abbreviated form, Submission and Craving, showed a good agreement with the previously validated Relationships and Sentimental Dependencies Inventory (IRIDS-100). Conclusion The ADS-9 is a brief instrument that appears to reliably detect the dependent and pathological components of affective dependence. It consists of two sub-scales, describing Submission (adaptation, accommodation, and subjugation) and Craving (imperative need for the other with the presence of disturbing states). We suggest that it is a versatile scale that may be useful for clinicians and researchers.
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Affiliation(s)
- Carlos Miguel Sirvent-Ruiz
- Research and Teaching Department, Fundación Instituto Spiral, Madrid, Spain,Correspondence: Carlos Miguel Sirvent-Ruiz, Fundación Instituto Spiral, c/ Marqués de Valdeiglesias, 2, Madrid, 28004, Spain, Tel +34 985 111 111; +34 915 000 050, Email
| | | | - Juan Herrero
- Department of Psychology, University of Oviedo, Oviedo, Spain
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Elrassas HH, Morsy MH, Abdelrazek YM, El Rasheed AH, Saad NA, Azzam LA. The role of repetitive transcranial magnetic stimulation in reduction of opioid craving: a single-blinded randomized sham-controlled clinical trial. MIDDLE EAST CURRENT PSYCHIATRY 2022. [DOI: 10.1186/s43045-022-00265-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Abstract
Background
Opioid use disorder (OUD) poses a great concern due to problems associated with their abuse as well as fatal and non-fatal overdose consequences. Craving has a complex relationship with opioid use and relapse. Developing new, effective treatments for substance use disorders (SUDs), including opioid use disorders is crucial. This study aimed to assess the effect of 18 sessions of high-frequency (HF) repetitive transcranial magnetic stimulation (rTMS) over the left dorsolateral prefrontal cortex (DLPFC) on opioid craving in 26 OUD male patients compared to sham rTMS in 26 OUD patients, during early abstinence, with craving assessment using brief substance craving scale (BSCS) for tramadol and morphine and heroin craving questionnaire (HCQ) for heroin craving.
Results
There was a statistically significant reduction in craving scores in the group of OUD patients receiving real rTMS compared to those receiving sham rTMS for both BSCS (p value = 0.044) and HCQ (p value=0.002). A statistically significant positive correlation was revealed between the number of hospital admissions and the mean scores of post-rTMS HCQ scores (r=0.05, p value= 0.040).
Conclusions
A high frequency of 10-Hz rTMS over the left DLPFC for 18 treatment sessions reduced craving OUD patients during early abstinence. These preliminary results suggest that 10-Hz rTMS of the left DLPFC may be used in the treatment of OUD, so our study recommends that the use of rTMS in the reduction of opioid craving in early abstinence.
Trial registration
Unique identification number PACTR202206487514449 in the Pan African Clinical Trial Registry retrospectively (www.pactr.org) registered on 10 June 2022.
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Kelley AT, Incze MA, Baylis JD, Calder SG, Weiner SJ, Zickmund SL, Jones AL, Vanneman ME, Conroy MB, Gordon AJ, Bridges JF. Patient-centered quality measurement for opioid use disorder: Development of a taxonomy to address gaps in research and practice. Subst Abus 2022; 43:1286-1299. [PMID: 35849749 PMCID: PMC9703846 DOI: 10.1080/08897077.2022.2095082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Background: Evidence-based treatment is provided infrequently and inconsistently to patients with opioid use disorder (OUD). Treatment guidelines call for high-quality, patient-centered care that meets individual preferences and needs, but it is unclear whether current quality measures address individualized aspects of care and whether measures of patient-centered OUD care are supported by evidence. Methods: We conducted an environmental scan of OUD care quality to (1) evaluate patient-centeredness in current OUD quality measures endorsed by national agencies and in national OUD treatment guidelines; and (2) review literature evidence for patient-centered care in OUD diagnosis and management, including gaps in current guidelines, performance data, and quality measures. We then synthesized these findings to develop a new quality measurement taxonomy that incorporates patient-centered aspects of care and identifies priority areas for future research and quality measure development. Results: Across 31 endorsed OUD quality measures, only two measures of patient experience incorporated patient preferences and needs, while national guidelines emphasized providing patient-centered care. Among 689 articles reviewed, evidence varied for practices of patient-centered care. Many practices were supported by guidelines and substantial evidence, while others lacked evidence despite guideline support. Our synthesis of findings resulted in EQuIITable Care, a taxonomy comprised of six classifications: (1) patient Experience and engagement, (2) Quality of life; (3) Identification of patient risks; (4) Interventions to mitigate patient risks; (5) Treatment; and (6) Care coordination and navigation. Conclusions: Current quality measurement for OUD lacks patient-centeredness. EQuIITable Care for OUD provides a roadmap to develop measures of patient-centered care for OUD.
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Affiliation(s)
- A. Taylor Kelley
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Vulnerable Veteran Innovative Patient-aligned Care Team (VIP), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Michael A. Incze
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jacob D. Baylis
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Vulnerable Veteran Innovative Patient-aligned Care Team (VIP), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Spencer G. Calder
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Vulnerable Veteran Innovative Patient-aligned Care Team (VIP), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Saul J. Weiner
- Center of Innovation for Complex Chronic Healthcare, Jesse Brown VA Chicago Health Care System, Chicago, Illinois, USA
- Division of Academic Internal Medicine and Geriatrics, Department of Medicine, The University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Susan L. Zickmund
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Audrey L. Jones
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Vulnerable Veteran Innovative Patient-aligned Care Team (VIP), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Megan E. Vanneman
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Molly B. Conroy
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Adam J. Gordon
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Vulnerable Veteran Innovative Patient-aligned Care Team (VIP), VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Program for Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - John F.P. Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio, USA
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Samson KR, Xu W, Kortagere S, España RA. Intermittent access to oxycodone decreases dopamine uptake in the nucleus accumbens core during abstinence. Addict Biol 2022; 27:e13241. [PMID: 36301217 PMCID: PMC10262085 DOI: 10.1111/adb.13241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/29/2022] [Accepted: 09/27/2022] [Indexed: 01/24/2023]
Abstract
A major obstacle in treating opioid use disorder is the persistence of drug seeking or craving during periods of abstinence, which is believed to contribute to relapse. Dopamine transmission in the mesolimbic pathway is posited to contribute to opioid reinforcement, but the processes by which dopamine influences drug seeking have not been completely elucidated. To examine whether opioid seeking during abstinence is associated with alterations in dopamine transmission, female and male rats self-administered oxycodone under an intermittent access schedule of reinforcement. Following self-administration, rats underwent a forced abstinence period, and cue-induced seeking tests were conducted to assess oxycodone seeking. One day following the final seeking test, rats were sacrificed to perform ex vivo fast scan cyclic voltammetry and western blotting in the nucleus accumbens. Rats displayed reduced dopamine uptake rate on abstinence day 2 and abstinence day 15, compared to oxycodone-naïve rats. Further, on abstinence day 15, rats had reduced phosphorylation of the dopamine transporter. Additionally, local application of oxycodone to the nucleus accumbens reduced dopamine uptake in oxycodone-naïve rats and in rats during oxycodone abstinence, on abstinence day 2 and abstinence day 15. These observations suggest that abstinence from oxycodone results in dysfunctional dopamine transmission, which may contribute to sustained oxycodone seeking during abstinence.
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Affiliation(s)
- Kyle R. Samson
- Drexel University College of Medicine, Department of Neurobiology and Anatomy
| | - Wei Xu
- Drexel University College of Medicine, Department of Microbiology and Immunology
| | - Sandhya Kortagere
- Drexel University College of Medicine, Department of Microbiology and Immunology
| | - Rodrigo A. España
- Drexel University College of Medicine, Department of Neurobiology and Anatomy
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Bhoora U, Gloeck NR, Scheibe A. Managing acute opioid withdrawal with tramadol during COVID-19 lockdown in a peri-urban setting. Afr J Prim Health Care Fam Med 2022; 14:e1-e9. [PMID: 36226932 PMCID: PMC9557935 DOI: 10.4102/phcfm.v14i1.3386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 06/05/2022] [Accepted: 06/09/2022] [Indexed: 11/06/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) has highlighted the scope of heroin dependence and need for evidence-based treatment amongst marginalised people in South Africa. Acute opioid withdrawal management without maintenance therapy carries risks of increased morbidity and mortality. Due to the high costs of methadone, Tshwane’s Community Oriented Substance Use Programme (COSUP) used tramadol for opioid withdrawal management during the initial COVID-19 response. Aim To describe demographics, route of heroin administration and medication-related experiences amongst people accessing tramadol for treatment of opioid withdrawal. Setting Three community-based COSUP sites in Mamelodi (Tshwane, South Africa). Methods A retrospective cross-sectional study was conducted. Data were collected using an interviewer-administered paper-based tool between April and August 2020. Descriptive statistics were used to analyse data. Results Of the 220 service users initiated onto tramadol, almost half (n = 104, 47%) were not contactable. Fifty-eight (26%) people participated, amongst whom most were male (n = 55, 95%). Participants’ median age was 32 years. Most participants injected heroin (n = 36, 62.1%). Most participants experienced at least one side effect (n = 47, 81%) with 37 (64%) experiencing two or more side effects from tramadol. Insomnia occurred most frequently (n = 26, 45%). One person without a history of seizures experienced a seizure. Opioid withdrawal symptoms were experienced by 54 participants (93%) whilst taking tramadol. Over half (n = 38, 66%) reported using less heroin whilst on tramadol. Conclusion Tramadol reduced heroin use but was associated with withdrawal symptoms and unfavourable side effects. Findings point to the limitations of tramadol as opioid withdrawal management to retain people in care and the importance of access to first-line opioid agonists. Contribution This research contributes to the limited data around short-acting tramadol for opioid withdrawal management in the African context, with specific focus on the need for increased access to opioid agonists for those who need them, in primary care settings.
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Affiliation(s)
- Urvisha Bhoora
- Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria.
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Abstract
While substance experimentation typically begins in adolescence, substance use disorders (SUDs) usually develop in late teens or early adulthood, often in individuals who are vulnerable because of biological and socioeconomic risk factors. Severe SUDs-synonymous with addiction-involve changes in limbic and prefrontal brain areas after chronic drug exposure. These changes involve learned associations between drug reward and cues that trigger the anticipation of that reward (known as incentive salience), as well as heightened dysphoria during withdrawal and weakened prefrontal circuits needed for inhibiting habitual responses.
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Affiliation(s)
- Wilson M Compton
- National Institute on Drug Abuse, 301 North Stonestreet Avenue, MSC 6025, Bethesda, MD 20892-6025, USA.
| | - Eric M Wargo
- National Institute on Drug Abuse, 301 North Stonestreet Avenue, MSC 6025, Bethesda, MD 20892-6025, USA
| | - Nora D Volkow
- National Institute on Drug Abuse, 301 North Stonestreet Avenue, MSC 6025, Bethesda, MD 20892-6025, USA
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Ellis JD, Mun CJ, Epstein DH, Phillips KA, Finan PH, Preston KL. Intra-individual variability and stability of affect and craving among individuals receiving medication treatment for opioid use disorder. Neuropsychopharmacology 2022; 47:1836-1843. [PMID: 35668168 PMCID: PMC9372042 DOI: 10.1038/s41386-022-01352-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/05/2022] [Accepted: 05/23/2022] [Indexed: 01/10/2023]
Abstract
Affect and craving are dynamic processes that are clinically relevant in opioid use disorder (OUD) treatment, and can be quantified in terms of intra-individual variability and stability. The purpose of the present analysis was to explore associations between opioid use and variability and stability of affect and craving among individuals receiving medication treatment for OUD (MOUD). Adults (N = 224) with OUD in outpatient methadone or buprenorphine treatment completed ecological momentary assessment (EMA) prompts assessing positive affect, negative affect, opioid craving, and opioid use. Dynamic structural equation modeling (DSEM) was used to quantify person-level indices of magnitude and stability of change. Beta regression was used to examine associations between intra-individual variability and stability and proportion of opioid-use days, when controlling for overall intensity of affect and craving. Results suggested that greater magnitude of craving variability was associated with opioid use on a greater proportion of days, particularly among individuals with lower average craving. Low average positive affect was also associated with higher proportion of days of use. Individuals who experience substantial craving variability in the context of lower average craving may be particularly vulnerable to opioid use during treatment. Ongoing assessment of craving may be useful in identifying treatment needs. Examining correlates of intra-individual variability and stability in MOUD treatment remains a relevant direction for future work.
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Affiliation(s)
- Jennifer D Ellis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Chung Jung Mun
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - David H Epstein
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Karran A Phillips
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA
| | - Patrick H Finan
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Kenzie L Preston
- Intramural Research Program, National Institute on Drug Abuse, Baltimore, MD, USA.
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Parikh A, Moeller SJ, Garland EL. Simulated opioid choice linked to opioid use disorder severity among veterans with chronic pain: initial validation of a novel paradigm. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:403-412. [PMID: 35100056 PMCID: PMC9339010 DOI: 10.1080/00952990.2021.2007258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 11/09/2021] [Accepted: 11/12/2021] [Indexed: 06/14/2023]
Abstract
Background: Modeling addictive behavior among individuals with, or at risk for, opioid use disorder (OUD) in a way that is accurate, ethical, and reproducible presents a pressing concern. OUD risk is elevated among people with chronic pain on long-term opioid therapy (LTOT).Objectives: To provide initial validation of a novel opioid preference task as an index of OUD and its symptomatology among veterans prescribed opioids for chronic pain, a population at high risk for poor opioid-related outcomes. The relative ease by which such a paradigm can be implemented and performed in clinical contexts, including enabling investigation of opioid reinforcement and drug-seeking behavior while avoiding ethical pitfalls associated with direct drug administration, could make this task an attractive approach for potentially tracking OUD symptoms.Methods: We studied 87 veterans (74 males, 13 females) on LTOT for chronic pain - 33 of whom had OUD diagnoses. Participants completed a picture-viewing choice task to assess preference for viewing opioid-related images in comparison with standardized pleasant, unpleasant, neutral, and blank images. Opioid-related choice, measured by vigor of button pressing, was tested for association with OUD severity (measured by symptom counts), as well as craving and anhedonia.Results: Choice for opioid-related images was positively correlated with OUD severity (i.e., number of DSM-5 measured OUD symptoms) (r = 0.38, p < .001), particularly among those meeting diagnostic criteria for OUD (r = 0.47, p = .006). Neither craving nor anhedonia correlated with opioid-related choice.Conclusions: Our results provide initial validation for a new opioid picture-choice paradigm in patients with chronic pain.
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Affiliation(s)
- Apurva Parikh
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Scott J. Moeller
- Department of Psychiatry, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY
| | - Eric L. Garland
- University of Utah Center on Mindfulness and Integrative Health Intervention Development, Salt Lake City, UT
- College of Social Work, University of Utah, Salt Lake City, UT
- Veterans Health Care Administration VISN 19 Whole Health Flagship site located at the VA Salt Lake City Health Care System, Salt Lake City, UT
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A neuroeconomic signature of opioid craving: How fluctuations in craving bias drug-related and nondrug-related value. Neuropsychopharmacology 2022; 47:1440-1448. [PMID: 34916590 PMCID: PMC9205977 DOI: 10.1038/s41386-021-01248-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/24/2021] [Indexed: 12/24/2022]
Abstract
How does craving bias decisions to pursue drugs over other valuable, and healthier, alternatives in addiction? To address this question, we measured the in-the-moment economic decisions of people with opioid use disorder as they experienced craving, shortly after receiving their scheduled opioid maintenance medication and ~24 h later. We found that higher cravers had higher drug-related valuation, and that moments of higher craving within-person also led to higher drug-related valuation. When experiencing increased opioid craving, participants were willing to pay more for personalized consumer items and foods more closely related to their drug use, but not for alternative "nondrug-related" but equally desirable options. This selective increase in value with craving was greater when the drug-related options were offered in higher quantities and was separable from the effects of other fluctuating psychological states like negative mood. These findings suggest that craving narrows and focuses economic motivation toward the object of craving by selectively and multiplicatively amplifying perceived value along a "drug relatedness" dimension.
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Medications for Opioid Use Disorder During Incarceration. J Addict Nurs 2022; 33:182-190. [DOI: 10.1097/jan.0000000000000482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Khatri UG, Lee K, Lin T, D'Orazio JL, Patel MS, Shofer FS, Perrone J. A Brief Educational Intervention to Increase ED Initiation of Buprenorphine for Opioid Use Disorder (OUD). J Med Toxicol 2022; 18:205-213. [PMID: 35415804 PMCID: PMC9004452 DOI: 10.1007/s13181-022-00890-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 03/07/2022] [Accepted: 03/10/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Despite the evidence in support of the use of buprenorphine in the treatment of OUD and increasing ability of emergency medicine (EM) clinicians to prescribe it, emergency department (ED)-initiated buprenorphine is uncommon. Many EM clinicians lack training on how to manage acute opioid withdrawal or initiate treatment with buprenorphine. We developed a brief buprenorphine training program and assessed the impact of the training on subsequent buprenorphine initiation and knowledge retention. METHODS We conducted a pilot randomized control trial enrolling EM clinicians to receive either a 30-min didactic intervention about buprenorphine (standard arm) or the didactic plus weekly messaging and a monetary inducement to administer and report buprenorphine use (enhanced arm). All participants were incentivized to complete baseline, immediate post-didactic, and 90-day knowledge and attitude assessment surveys. Our objective was to achieve first time ED buprenorphine prescribing events in clinicians who had not previously prescribed buprenorphine in the ED and to improve EM-clinician knowledge and perceptions about ED-initiated buprenorphine. We also assessed whether the incentives and reminder messaging in the enhanced arm led to more clinicians administering buprenorphine than those in the standard arm following the training; we measured changes in knowledge of and attitudes toward ED-initiated buprenorphine. RESULTS Of 104 EM clinicians enrolled, 51 were randomized to the standard arm and 53 to the enhanced arm. Clinical knowledge about buprenorphine improved for all clinicians immediately after the didactic intervention (difference 19.4%, 95% CI 14.4% to 24.5%). In the 90 days following the intervention, one-third (33%) of all participants reported administering buprenorphine for the first time. Clinicians administered buprenorphine more frequently in the enhanced arm compared to the standard arm (40% vs. 26.3%, p = 0.319), but the difference was not statistically significant. The post-session knowledge improvement was not sustained at 90 days in the enhanced (difference 9.6%, 95% CI - 0.37% to 19.5%) or in the standard arm (difference 3.7%, 95% CI - 5.8% to 13.2%). All the participants reported an increased ability to recognize patients with opioid withdrawal at 90 days (enhanced arm difference .55, 95% CI .01-1.09, standard arm difference .85 95% CI .34-1.37). CONCLUSIONS A brief educational intervention targeting EM clinicians can be utilized to achieve first-time prescribing and improve knowledge around buprenorphine and opioid withdrawal. The use of weekly messaging and gain-framed incentivization conferred no additional benefit to the educational intervention alone. In order to further expand evidence-based ED treatment of OUD, focused initiatives that improve clinician competence with buprenorphine should be explored. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03821103.
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Affiliation(s)
- Utsha G Khatri
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA, USA.
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA.
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY, 10029, USA.
| | - Kathleen Lee
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Medicine Center for Digital Health, Center for Health Care Innovation, Perelman School of Medicine, Philadelphia, PA, USA
| | - Theodore Lin
- Penn Medicine Center for Digital Health, Center for Health Care Innovation, Perelman School of Medicine, Philadelphia, PA, USA
| | - Joseph L D'Orazio
- Department of Emergency Medicine, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Mitesh S Patel
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Health Care Management, Wharton School, University of Pennsylvania, Philadelphia, PA, USA
- Penn Medicine Nudge Unit, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Frances S Shofer
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Epidemiology & Biostatistics, Center for Public Health, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeanmarie Perrone
- Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Medicine Center for Addiction Medicine and Policy, Philadelphia, PA, USA
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Lamey PS, Landis DM, Nugent KM. Iatrogenic opioid withdrawal syndromes in adults in intensive care units: a narrative review. J Thorac Dis 2022; 14:2297-2308. [PMID: 35813766 PMCID: PMC9264079 DOI: 10.21037/jtd-22-157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/12/2022] [Indexed: 11/08/2022]
Abstract
Background and Objective In hospitalized patients, opiates are essential analgesics and sedatives used in intensive care unit (ICU) patients. However, the iatrogenic opioid withdrawal syndrome (IOWS) in ICU patients has been poorly characterized, and there are no well accepted, standardized diagnostic tools for hospitalized adults. This review analyzed recent clinical studies to determine the frequency, characteristics, and treatment of IOWS in critically ill adults. Methods The initial literature search used the PubMed MeSH terms “Analgesics”, “Opioids”, “Iatrogenic Disease”, and “Neurobiology”. The main focus was on clinical studies describing IOWS in adults receiving intravenous opioids in ICUs. Key Content and Findings Review of 8 studies indicated that IOWS occurs in 15% to 40% of patients in intensive care units who required opioid infusions. These reports included patients in medical ICUs, trauma ICUs, surgical ICUs, and burn ICUs; many patients also received sedative drugs. Most of the studies used DSM-5 criteria to identify the syndrome. Factors which predicted the development of this syndrome varied from study to study; important considerations included the weaning rate for the opioid, the duration of opioid infusion, and the concomitant infusion of benzodiazepines. Treatment approaches included the reinstitution of the opioid infusion with slower reductions in the rate and the use of an alpha-2 agonist, such dexmedetomidine or clonidine. Many patients appeared to recover without specific treatment.
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Affiliation(s)
- Patrice S Lamey
- The Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Dylan M Landis
- The Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Kenneth M Nugent
- The Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Parisi A, Landicho HL, Hudak J, Leknes S, Froeliger B, Garland EL. Emotional distress and pain catastrophizing predict cue-elicited opioid craving among chronic pain patients on long-term opioid therapy. Drug Alcohol Depend 2022; 233:109361. [PMID: 35278786 PMCID: PMC9466292 DOI: 10.1016/j.drugalcdep.2022.109361] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Individuals who use illicit substances exhibit cue-elicited craving and autonomic cue-reactivity when exposed to cues associated with past drug use. However, little is known about this phenomenon among chronic pain patients on long-term opioid therapy (LTOT). Negative cognitive-emotional reactivity in general (e.g., distress) and cognitive-emotional reactivity specific to pain (e.g., pain catastrophizing) might drive cue-reactivity independent of pain severity. Here we examined emotional distress and pain catastrophizing as predictors of cue-reactivity among a sample of chronic pain patients receiving LTOT. We also tested whether associations between distress, catastrophizing, and cue-reactivity differed as a function of opioid misuse status. MATERIALS AND METHODS Patients receiving LTOT (N = 243) were classified as exhibiting aberrant behavior consistent with opioid misuse (MISUSE+, n = 145) or as using opioids as prescribed (MISUSE-, n = 97). Participants completed assessments of pain catastrophizing and emotional distress and then participated in an opioid cue-reactivity task one week later. Cue-elicited opioid craving and autonomic cue-reactivity were measured with craving ratings and high-frequency heart rate variability (HRV), respectively. RESULTS Distress and catastrophizing predicted cue-elicited craving and HRV, whereas pain severity did not. Misuser status moderated the relationship between emotional distress and self-reported craving, such that higher levels of distress predicted craving among the MISUSE+ group, but not among the MISUSE- group. No moderating effects were found for catastrophizing. CONCLUSIONS Findings suggest that although opioids are prescribed for analgesia, the exacerbating influence of negative cognitive-emotional reactivity, both in general and specific to pain, on cue-elicited opioid craving extends beyond the effects of pain severity alone.
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Affiliation(s)
- Anna Parisi
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, USA; College of Social Work, University of Utah, USA
| | - Hannah Louise Landicho
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, USA; College of Social Work, University of Utah, USA
| | - Justin Hudak
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, USA; College of Social Work, University of Utah, USA
| | - Siri Leknes
- Department of Psychology, University of Oslo, USA
| | - Brett Froeliger
- Department of Psychiatry; Department of Psychological Sciences, University of Missouri, USA
| | - Eric L. Garland
- Center on Mindfulness and Integrative Health Intervention Development, University of Utah, USA; College of Social Work, University of Utah, USA
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Florence L, Lassi DLS, Kortas GT, Lima DR, de Azevedo-Marques Périco C, Andrade AG, Torales J, Ventriglio A, De Berardis D, De Aquino JP, Castaldelli-Maia JM. Brain Correlates of the Alcohol Use Disorder Pharmacotherapy Response: A Systematic Review of Neuroimaging Studies. Brain Sci 2022; 12:brainsci12030386. [PMID: 35326342 PMCID: PMC8946664 DOI: 10.3390/brainsci12030386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/04/2022] [Accepted: 03/05/2022] [Indexed: 01/17/2023] Open
Abstract
Background: Although Alcohol Use Disorder (AUD) is highly prevalent worldwide, treating this condition remains challenging. Further, potential treatments for AUD do not fully address alcohol-induced neuroadaptive changes. Understanding the effects of pharmacotherapies for AUD on the human brain may lead to tailored, more effective treatments, and improved individual clinical outcomes. Objectives: We systematically reviewed the literature for studies investigating pharmacotherapies for AUD that included neuroimaging-based treatment outcomes. We searched the PubMed, Scielo, and PsycINFO databases up to January 2021. Study eligibility criteria, participants, and interventions: Eligible studies included those investigating pharmacotherapies for AUD and employing functional magnetic resonance imaging (fMRI), positron emission tomography (PET), single-photon emission computed tomography (SPECT), and/or proton magnetic resonance spectroscopy (H-MRS). Study appraisal and synthesis methods: Two independent reviewers screened studies’ titles and abstracts for inclusion. Data extraction forms were shared among all the authors to standardize data collection. We gathered information on the following variables: sample size; mean age; sociodemographic and clinical characteristics; alcohol use status; study design and methodology; main neuroimaging findings and brain-regions of interest (i.e., brain areas activated by alcohol use and possible pharmacological interactions); and limitations of each study. Results: Out of 177 studies selected, 20 studies provided relevant data for the research topic. Findings indicate that: (1) Acamprosate and gabapentin may selectively modulate limbic regions and the anterior cingulate cortex; (2) Naltrexone and disulfiram effects may involve prefrontal, premotor, and cerebellar regions; (3) Pharmacotherapies acting on glutamate and GABA neurotransmission involve primarily areas underpinning reward and negative affective states, and; (4) Pharmacotherapies acting on opioid and dopamine systems may affect areas responsible for the cognitive and motor factors of AUD. Limitations: Most of the studies were focused on naltrexone. A small number of studies investigated the action of disulfiram and gabapentin, and no neuroimaging studies investigated topiramate. In addition, the time between medication and neuroimaging scans varied widely across studies. Conclusions: We identified key-brain regions modulated by treatments available for AUD. Some of the regions modulated by naltrexone are not specific to the brain reward system, such as the parahippocampal gyrus (temporal lobe), parietal and occipital lobes. Other treatments also modulate not specific regions of the reward system, but play a role in the addictive behaviors, including the insula and dorsolateral prefrontal cortex. The role of these brain regions in mediating the AUD pharmacotherapy response warrants investigation in future research studies.
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Affiliation(s)
- Luiza Florence
- Department of Neuroscience, FMABC University Center, Santo André 09060-870, SP, Brazil; (L.F.); (C.d.A.-M.P.); (A.G.A.)
| | - Dângela Layne Silva Lassi
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo 05508-060, SP, Brazil; (D.L.S.L.); (G.T.K.); (D.R.L.)
| | - Guilherme T. Kortas
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo 05508-060, SP, Brazil; (D.L.S.L.); (G.T.K.); (D.R.L.)
| | - Danielle R. Lima
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo 05508-060, SP, Brazil; (D.L.S.L.); (G.T.K.); (D.R.L.)
| | | | - Arthur G. Andrade
- Department of Neuroscience, FMABC University Center, Santo André 09060-870, SP, Brazil; (L.F.); (C.d.A.-M.P.); (A.G.A.)
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo 05508-060, SP, Brazil; (D.L.S.L.); (G.T.K.); (D.R.L.)
| | - Julio Torales
- Department of Psychiatry, National University of Asunción, San Lorenzo 2064, Paraguay;
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Domenico De Berardis
- Mental Health Center of Giulianova, Asl Teramo, 64021 Giulianova, Italy;
- Department of Neurosciences and Imaging, University “G. D’Annunzio” Chieti, 66100 Chieti, Italy
- International Centre for Education and Research in Neuropsychiatry, University of Samara, 443100 Samara, Russia
| | - João P. De Aquino
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510, USA;
| | - João M. Castaldelli-Maia
- Department of Neuroscience, FMABC University Center, Santo André 09060-870, SP, Brazil; (L.F.); (C.d.A.-M.P.); (A.G.A.)
- Department of Psychiatry, Medical School, University of São Paulo, São Paulo 05508-060, SP, Brazil; (D.L.S.L.); (G.T.K.); (D.R.L.)
- Correspondence:
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Zhou W, Wang Y, Wang M, Wang Z, Zheng H, Wang M, Potenza MN, Dong G. Connectome-based prediction of craving for gaming in internet gaming disorder. Addict Biol 2022; 27:e13076. [PMID: 34176197 DOI: 10.1111/adb.13076] [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: 02/09/2021] [Revised: 06/15/2021] [Accepted: 06/18/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Craving-related brain responses have been associated with the emergence and maintenance of addictions. However, little is known about brain network organizations underlying cravings in internet gaming disorder (IGD). METHODS Sixty-six IGD subjects and 61 matched individuals with recreational game use (RGU) were scanned while performing a cue-craving task. A recently developed whole-brain analysis approach, connectome-based predictive modelling (CPM) with leave-one-out cross-validation was conducted to identify networks that predicted craving responses in IGD. Then, the craving network was tested in different brain states (cue-craving under deprivation) to investigate replicability. RESULTS CPM identified an IGD craving network, as indicated by a significant correspondence between predicted and actual craving values (r = 0.49, p < 0.001), characterized by within-network default mode (DMN) connectivity and connectivity between canonical networks implicated in executive/cognitive control (frontoparietal, medial frontal, DMN) and reward responsiveness (subcortical, motor/sensory). Network strength in the cue-craving task during gaming deprivation also predicted IGD craving scores (r = 0.43, p = 0.017), indicating network replication across brain states. CONCLUSIONS The CPM results demonstrate that individual differences in cognitive, attention, and control network function can predict craving intensities in IGD subjects. These networks may be targets for potential interventions using brain modulation.
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Affiliation(s)
- Wei‐ran Zhou
- Center for Cognition and Brain Disorders The Affiliated Hospital of Hangzhou Normal University Hangzhou Zhejiang Province China
- Institutes of Psychological Sciences Hangzhou Normal University Hangzhou Zhejiang Province China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments Hangzhou Zhejiang Province China
- College of Education Hangzhou Normal University Hangzhou Zhejiang Province China
| | - Yi‐ming Wang
- College of Education Hangzhou Normal University Hangzhou Zhejiang Province China
| | - Min Wang
- Center for Cognition and Brain Disorders The Affiliated Hospital of Hangzhou Normal University Hangzhou Zhejiang Province China
- Institutes of Psychological Sciences Hangzhou Normal University Hangzhou Zhejiang Province China
| | - Zi‐liang Wang
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research Beijing Normal University Beijing China
| | - Hui Zheng
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center Shanghai Jiaotong University School of Medicine Shanghai China
| | - Meng‐jing Wang
- Southeast University ‐ Monash University Joint Graduate School Southeast University Nanjing China
| | - Marc N. Potenza
- Department of Psychiatry and the Child Study Center Yale University School of Medicine New Haven Connecticut USA
- Department of Neuroscience Yale University New Haven Connecticut USA
- Connecticut Council on Problem Gambling Wethersfield Connecticut USA
- Connecticut Mental Health Center New Haven Connecticut USA
| | - Guang‐Heng Dong
- Center for Cognition and Brain Disorders The Affiliated Hospital of Hangzhou Normal University Hangzhou Zhejiang Province China
- Institutes of Psychological Sciences Hangzhou Normal University Hangzhou Zhejiang Province China
- Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments Hangzhou Zhejiang Province China
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Verzijl CL, Gius B, Schlauch R, Rancourt D. The transdiagnostic role of food craving: An application of substance use models. Appetite 2021; 170:105867. [PMID: 34915105 DOI: 10.1016/j.appet.2021.105867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 09/06/2021] [Accepted: 12/11/2021] [Indexed: 12/15/2022]
Abstract
Food craving is a transdiagnostic process underlying clinically significant disordered eating behaviors and eating disorder diagnoses. However, the lack of literature examining the role of food craving as it relates to the full spectrum of disordered eating behaviors, including restrictive eating and compensatory behaviors, may be due to the traditional definition of food craving as the desire to consume particular foods. Applying motivational models of substance use craving to food craving may help to explain inconsistencies within existing literature. Three motivational models of craving from the substance use literature may be particularly applicable to (1) provide a clear definition of food craving as a motivational process, (2) understand the role of that motivational process as it underlies the full spectrum of disordered eating behavioral patterns, (3) provide insight for the most appropriate ways in which to accurately assess food craving, and (4) establish ways in which food craving may represent a useful motivational process to target in eating disorder treatments. This narrative review describes three models of substance use craving and provides suggestions for utilizing motivational models to understand the transdiagnostic role of food craving as it relates to the full spectrum of disordered eating behaviors in both research and clinical work.
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Affiliation(s)
- Christina L Verzijl
- Department of Psychology, University of South Florida, 4202 East Fowler Ave, Tampa, FL, 33620, USA.
| | - Becky Gius
- Department of Psychology, University of South Florida, 4202 East Fowler Ave, Tampa, FL, 33620, USA
| | - Robert Schlauch
- Department of Psychology, University of South Florida, 4202 East Fowler Ave, Tampa, FL, 33620, USA
| | - Diana Rancourt
- Department of Psychology, University of South Florida, 4202 East Fowler Ave, Tampa, FL, 33620, USA
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Boyett B, Wiest K, McLeod LD, Nelson LM, Bickel WK, Learned SM, Heidbreder C, Fudala PJ, Le Moigne A, Zhao Y. Assessment of craving in opioid use disorder: Psychometric evaluation and predictive validity of the opioid craving VAS. Drug Alcohol Depend 2021; 229:109057. [PMID: 34794061 DOI: 10.1016/j.drugalcdep.2021.109057] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/26/2021] [Accepted: 08/28/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND This work evaluated the psychometric properties of the single-item Opioid Craving Visual Analog Scale (OC-VAS) for opioid use disorder (OUD). METHODS Psychometric evaluation of the OC-VAS (range: 0-100 mm) was supported by Subjective Opiate Withdrawal Scale (SOWS) item 16 and total score, Clinical Opiate Withdrawal Scale (COWS) scores, and the 36-Item Short-Form Health Survey, using data from phase 3 study (NCT02357901; N = 487) participants who received randomized treatment and completed the OC-VAS at screening. Descriptive properties, test-retest reliability, construct validity, known-groups validity, and responsiveness were assessed. Interpretation of meaningful change and predictive validity were also explored. RESULTS Descriptive properties for the OC-VAS at screening did not provide evidence of problematic floor/ceiling effects or missingness. The test-retest reliability was established by weekly intraclass correlations >0.70. At the screening and end of the study, the strong positive correlations between OC-VAS and SOWS Total/Item 16 score and the significant OC-VAS differences among COWS severity groups supported construct validity and known-groups (discriminating ability) validity, respectively. The associations between the changes in OC-VAS and in supporting measures/opioid use from screening to the end of the study demonstrated responsiveness and the ability to detect change in clinical status. During the induction and randomization treatment periods, significant relationships were identified between OC-VAS score and subsequent opioid use. CONCLUSIONS This psychometric evaluation of the OC-VAS performed on a large OUD patient population provides evidence to support its use to measure the severity of opioid craving and its ability to predict opioid use.
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Affiliation(s)
- Brent Boyett
- Bradford Health Services, Birmingham, AL, United States
| | | | - Lori D McLeod
- RTI Health Solutions, Research Triangle Park, NC, United States
| | - Lauren M Nelson
- RTI Health Solutions, Research Triangle Park, NC, United States
| | - Warren K Bickel
- Addiction Recovery Research Center, Fralin Biomedical Research Institute at VTC, Roanoke, VA, United States
| | | | | | - Paul J Fudala
- Indivior Inc., North Chesterfield, VA, United States
| | | | - Yue Zhao
- Indivior Inc., North Chesterfield, VA, United States
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Abstract
Illicit drug use/misuse among older adults is understudied, although current trends point to older adults being the fastest-growing segment in the United States and other developed countries. There is a need for further insight into drug use patterns in older adults, who face their own set of socioeconomic, medical, and psychiatric problems. We reviewed the literature for data related to use/misuse of heroin and stimulants (cocaine, amphetamines, and methamphetamines) among people over the age of 40 years. We focused on prevalence rates of use/misuse of these substances, comorbidities, diagnostic challenges, screening tools, and treatment recommendations specific to the geriatric population.
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50
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Kiguchi N, Ko MC. Potential therapeutic targets for the treatment of opioid abuse and pain. ADVANCES IN PHARMACOLOGY (SAN DIEGO, CALIF.) 2021; 93:335-371. [PMID: 35341570 PMCID: PMC10948018 DOI: 10.1016/bs.apha.2021.09.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Although μ-opioid peptide (MOP) receptor agonists are effective analgesics available in clinical settings, their serious adverse effects put limits on their use. The marked increase in abuse and misuse of prescription opioids for pain relief and opioid overdose mortality in the past decade has seriously impacted society. Therefore, safe analgesics that produce potent analgesic effects without causing MOP receptor-related adverse effects are needed. This review highlights the potential therapeutic targets for the treatment of opioid abuse and pain based on available evidence generated through preclinical studies and clinical trials. To ameliorate the abuse-related effects of opioids, orexin-1 receptor antagonists and mixed nociceptin/MOP partial agonists have shown promising results in translational aspects of animal models. There are several promising non-opioid targets for selectively inhibiting pain-related responses, including nerve growth factor inhibitors, voltage-gated sodium channel inhibitors, and cannabinoid- and nociceptin-related ligands. We have also discussed several emerging and novel targets. The current medications for opioid abuse are opioid receptor-based ligands. Although neurobiological studies in rodents have discovered several non-opioid targets, there is a translational gap between rodents and primates. Given that the neuroanatomical aspects underlying opioid abuse and pain are different between rodents and primates, it is pivotal to investigate the functional profiles of these non-opioid compounds compared to those of clinically used drugs in non-human primate models before initiating clinical trials. More pharmacological studies of the functional efficacy, selectivity, and tolerability of these newly discovered compounds in non-human primates will accelerate the development of effective medications for opioid abuse and pain.
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Affiliation(s)
- Norikazu Kiguchi
- Department of Physiological Sciences, School of Pharmaceutical Sciences, Wakayama Medical University, Wakayama, Japan.
| | - Mei-Chuan Ko
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC, United States
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