Effects of naltrexone with nicotine replacement on smoking cue reactivity: preliminary results

Abstract

Although several studies have examined the effects of opioid antagonists on smoking behavior, there have been no reports of the potentially therapeutic combination of naltrexone and nicotine replacement therapy. The primary objective of the present study was to determine whether naltrexone reduced reactivity to smoking cues among abstinent smokers treated with nicotine replacement. Twenty participants were instructed to abstain from smoking cigarettes for 9 h while using nicotine replacement therapy. Participants were subsequently treated with either naltrexone (50 mg) or placebo before being exposed to smoking cues. Results indicated that the smokers who received the placebo responded to smoking cue exposure with increases in urge to smoke and increases in negative affect. Participants who received naltrexone did not show any increase in urge or negative affect and showed a decrease in withdrawal symptoms after exposure to smoking cues. Although preliminary, the findings suggest that naltrexone may work in combination with nicotine replacement therapies to block the effects of smoking stimuli in abstinent smokers.

Association of OPRM1 A118G variant with the relative reinforcing value of nicotine

“…In cell culture and animal studies, chronic exposure to naltrexone produces upregulation of MOR protein levels in the ventral tegmental area and nucleus accumbens, regions important in nicotine addiction (Tempel et al 1985). Previous laboratory investigations showing smoking reduction following naltrexone treatment have tested acute, single-dose administration, which would not be expected to produce upregulation in MOR (Epstein and King 2004;Hutchison et al 1999;King and Meyer 2000;Rukstalis et al 2005). However, other studies have documented reductions in smoking with short-term or long-term naltrexone treatment (Covey et al 1999;Wewers et al 1998) and with 100 mg naltrexone therapy (O'Malley et al 2006), suggesting that tolerance to naltrexone may not be an adequate explanation for the lack of medication effects in the present study.…”

Effects of topiramate on cue-induced cigarette craving and the response to a smoked cigarette in briefly abstinent smokers

“…Asterisk indicates p<0.05 for comparison of placebo versus topiramate in a one-way ANOVA address this suggestion. NRT has been shown to reduce symptoms of nicotine withdrawal after a 3-h to 3-day period of smoking abstinence (Rose et al 1985;Jorenby et al 1996;Tiffany et al 2000;West and Shiffman 2001), although its effects on cigarette craving have been mixed with some reporting a drop in craving (Jorenby et al 1996;Teneggi et al 2002) and others finding no change (Pickworth et al 1996;Hutchinson et al 1999). Bupropion has also been shown to reduce abstinence-related nicotine withdrawal (Shiffman et al 2000;Teneggi et al 2005), although effects on craving were less consistent (Teneggi et al 2005;Durcan et al 2002; but see Shiffman et al 2000;Cousins et al 2001a).…”

“…Once the cardiovascular measures and subjective rating scales were completed, 10 min of baseline skin conductance and skin temperature were recorded before commencing with cue exposure testing. The cue exposure sessions lasted 10 min and involved a combination of tactile, olfactory, visual, and audio cues modeled after previous studies (Drobes and Tiffany 1997;Mucha et al 1999;Hutchinson et al 1999;Shiffman et al 2003). Continuous measurements of skin conductance and skin temperature were collected during cue exposure.…”

Naltrexone reduces the relative reinforcing value of nicotine in a cigarette smoking choice paradigm

“…Naltrexone and naloxone have been investigated for effects on smoking in behavioral pharmacology studies (Epstein and King 2004;Hutchison et al 1999;King and Meyer 2000) and in clinical settings (Covey et al 1999). Acute pre-treatment with naloxone reduces cigarette consumption (Gorelick et al 1989;Karras and Kane 1980) and satisfaction (Palmer and Berens 1983) in some studies, but not in others (Nemeth-Coslett and Griffiths 1986).…”