Cannabinoid and opioid interactions: Implications for opiate dependence and withdrawal

Abstract

Withdrawal from opiates, such as heroin or oral narcotics, is characterized by a host of aversive physical and emotional symptoms. High rates of relapse and limited treatment success rates for opiate addiction have prompted a search for new approaches. For many opiate addicts, achieving abstinence may be further complicated by poly-drug use and co-morbid mental disorders. Research over the past decade has shed light on the influence of endocannabinoids on the opioid system. Evidence from both animal and clinical studies point towards an interaction between these two systems, and suggest that targeting the endocannabinoid system may provide novel interventions for managing opiate dependence and withdrawal. This review will summarize the literature surrounding the molecular effects of cannabinoids and opioids system on the locus coeruleus-norepinephrine system, a key circuit implicated in the negative sequelae of opiate addiction. A consideration of the trends and effects of marijuana use in those seeking treatment to abstain from opiates in the clinical setting will also be presented. In summary, the present review details how cannabinoid-opioid interactions may inform novel interventions in management of opiate dependence and withdrawal.

Neonatal Abstinence Syndrome

“…This is the principal noradrenergic nucleus of the brain and is extremely sensitive to opioid status. 78 A lack of opioids causes increased production of norepinephrine, 79 which is responsible for most of the signs of NAS. The ventral tegmental area of the midbrain, the storage center of dopamine, releases decreased dopamine during opioid withdrawal.…”

Fatty Acid Amide Hydrolase–morphine Interaction Influences Ventilatory Response to Hypercapnia and Postoperative Opioid Outcomes in Children

“…Declined (43) Study staff unavailable (13) Enrolled in another study (37) Patient late -no time to consent (2) 83 patients completed MV-CO 2 testing 120 study participants; 19 non-Caucasian -data collected but excluded from analysis; So 101 Caucasians followed as below ETCO2 ltering criteria Figure 1) after adjusting for sex and morphine. Specifically, there was highly significant (p < 0.0001) associations between HCVR and genetic variants: rs11576941, rs2295632, rs2295633, rs324420, rs6699322, rs3766246, rs45586133, rs6699322 and rs4141964.…”

“…FAAH is a gene coding for the enzyme FAAH, which hydrolyzes endocannabinoids like anandamide and other lipid classes [13,14]. Anandamide acts on cannabinoid (CB) receptors, and also potentiates opioid action, as evidenced by its attenuation of naloxoneinduced morphine withdrawal in mice [15,16].…”

Impact of Efficacy at theμ-Opioid Receptor on Antinociceptive Effects of Combinations ofμ-Opioid Receptor Agonists and Cannabinoid Receptor Agonists

“…Cannabinoid and opioid systems interact at multiple cellular and neurochemical levels (Vigano et al, 2005;Bushlin et al, 2010;Scavone et al, 2013). Opioid receptors and cannabinoid receptors are often colocalized on the same neurons (Salio et al, 2001) and interactions might occur through numerous extra-and intracellular signaling mechanisms.…”