Opioid dependence poses significant public health risks arising from associated morbidity and mortality caused by accidents, infectious disease, and social ramifications of crime and unemployment, among other complications. Opioid use, acute and chronic, is also associated with weight gain, glycemic dysregulation, and dental pathology. The literature supporting the connection between opiate use and development of preference for sweet tastes is reviewed, and further association with dental pathology, weight gain, and loss of glycemic control are considered. We discuss the impact of sweet tastes on the endogenous opioid system as well as clinical implications for analgesia and treating the opiate-dependent patient.
Little is known about the coupling of serotonin 5‐HT1B receptors to cellular signals other than cyclic AMP. In the present studies, the activation by 5‐HT1B receptors of p70 S6 kinase and the mitogen‐activated protein kinase (MAP kinase) ERK‐2 was investigated. Studies were performed by using both nontransfected Chinese hamster ovary (CHO) cells, which express endogenous receptors at a very low density, and a stable transfected CHO cell line expressing 5‐HT1B receptors at 230 fmol/mg of membrane protein, a density similar to that expressed in cortex. In nontransfected cells, 5‐HT was found to stimulate a greater than twofold increase in MAP kinase activity with an EC50 of 20 nM. Reflecting increased density of receptors, 5‐HT caused a greater than eightfold activation of ERK‐2 in transfected cells with an EC50 of 2 nM. 5‐HT was found to also stimulate p70 S6 kinase in both nontransfected and transfected cells. The stimulation was sixfold in both types of cells, but the EC50 for 5‐HT was fourfold lower in transfected cells. The coupling of 5‐HT1B receptors to ERK‐2 and to p70 S6 kinase was inhibited by pertussis toxin, inhibitors of phosphatidylinositol 3‐kinase, and by the inhibitor of MAP kinase kinase PD098059. Activation of p70 S6 kinase, but not ERK‐2, was also inhibited by rapamycin. These findings demonstrate that 5‐HT1B receptors couple to ERK‐2 and p70 S6 kinase through overlapping, but nonidentical, pathways.
There is increasing evidence that the kappa-opiate receptor, in addition to the mu-opiate receptor, plays an important role in substance use pathophysiology and behavior. As dopamine activity is upregulated through chronic substance use, kappa receptor activity, mediated through the peptide dynorphin, is upregulated in parallel. Dynorphin causes dysphoria and decreased locomotion, and the upregulation of its activity on the kappa receptor likely dampens the excitation caused by increased dopaminergic activity. This feedback mechanism may have significant clinical implications for treating drug dependent patients in various stages of their pathology.
Objective
To examine the course of mood symptoms following induction onto naltrexone, we examined change in total and symptom clusters of depression in newly abstinent opioid-dependent individuals being treated with depot naltrexone (Depotrex; BIOTEK).
Method
In a series of opioid-dependent patients (N=34) treated with naltrexone maintenance and behavioral therapy, mood was assessed with the 17-item Hamilton Depression Scale and subscale scores at baseline, and after naltrexone induction at 2- and 4-weeks post-baseline, using GEE models.
Results
Patients demonstrated high baseline affective burden and significant improvement of depression scores over a 4-week period post baseline (F2,66=8.88, p=0.0004). Somatic and cognitive-affective subscale scores significantly declined, as well as 7 individual item scores. By contrast, “late insomnia” score significantly increased by 2 weeks post-baseline, but did not remain significantly increased at 4 weeks post-baseline.
Conclusion
Naltrexone induction and maintenance in newly abstinent opioid-dependent individuals does not appear to be associated with the onset or worsening of depression; however, it may be associated with sleep impairment early in treatment.
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