Pharmacological treatments for drug misuse and dependence

Reed, Kylie; Day, Ed; Keen, Jenny; Strang, John

doi:10.1517/14656566.2015.983472

Cited by 17 publications

(26 citation statements)

References 40 publications

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“… 74 Although methadone has an encouraging safety profile, 75 it carries some risk for misuse and mortality when the dose exceeds the patient's level of tolerance. 76 , 77 Withdrawal symptoms from methadone mimic those of other opioids when stopped abruptly or tapered too quickly, and these symptoms last up to 3 weeks longer than withdrawal from other opioids. 9 , 78 , 79 There are only 1590 methadone distributers in the United States, which are highly regulated clinics that are concentrated in urban areas, creating geographical disparities in OUD treatment.…”

Section: Current Opioid Use Disorder Therapies and Their Shortcomingsmentioning

confidence: 99%

“…Buprenorphine (Subutex) is a partial MOR agonist and KOR antagonist that can reduce withdrawal symptoms, cravings, and additional opioid use. 76 , 81 , 82 The inclusion of naloxone in some buprenorphine formulations (Suboxone, Zubsolv) is intended to reduce misuse by precipitating withdrawal when it is used intravenously, 82 , 83 and despite the presence of naloxone, there is still some risk for misuse and overdose. 77 , 83 , 84 The inclusion of naloxone can also induce withdrawal when administered too soon after the most recent dose of other opioids.…”

Section: Current Opioid Use Disorder Therapies and Their Shortcomingsmentioning

confidence: 99%

“…Unlike methadone, Suboxone offers a primary care approach to medication-assisted therapy, as it can be dispensed by a pharmacy rather than a specialized clinic. 86 , 87 However, only 3% of physicians possess the additional Drug Enforcement Agency credentials required to prescribe buprenorphine, 76 , 88 and there are strict limits on the number of patients they are permitted to serve. 89 Buprenorphine-licensed physicians also tend to be concentrated in larger cities, leaving 46.8% of counties in the United States, especially rural areas and the Midwest, with a shortage in convenient access to these treatment options.…”

Section: Current Opioid Use Disorder Therapies and Their Shortcomingsmentioning

confidence: 99%

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Emerging Evidence for Cannabis' Role in Opioid Use Disorder

Wiese

Wilson-Poe

2018

Cannabis and Cannabinoid Research

127

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Introduction: The opioid epidemic has become an immense problem in North America, and despite decades of research on the most effective means to treat opioid use disorder (OUD), overdose deaths are at an all-time high, and relapse remains pervasive.Discussion: Although there are a number of FDA-approved opioid replacement therapies and maintenance medications to help ease the severity of opioid withdrawal symptoms and aid in relapse prevention, these medications are not risk free nor are they successful for all patients. Furthermore, there are legal and logistical bottlenecks to obtaining traditional opioid replacement therapies such as methadone or buprenorphine, and the demand for these services far outweighs the supply and access. To fill the gap between efficacious OUD treatments and the widespread prevalence of misuse, relapse, and overdose, the development of novel, alternative, or adjunct OUD treatment therapies is highly warranted. In this article, we review emerging evidence that suggests that cannabis may play a role in ameliorating the impact of OUD. Herein, we highlight knowledge gaps and discuss cannabis' potential to prevent opioid misuse (as an analgesic alternative), alleviate opioid withdrawal symptoms, and decrease the likelihood of relapse.Conclusion: The compelling nature of these data and the relative safety profile of cannabis warrant further exploration of cannabis as an adjunct or alternative treatment for OUD.

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Section: Current Opioid Use Disorder Therapies and Their Shortcomingsmentioning

confidence: 99%

Section: Current Opioid Use Disorder Therapies and Their Shortcomingsmentioning

confidence: 99%

Section: Current Opioid Use Disorder Therapies and Their Shortcomingsmentioning

confidence: 99%

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Emerging Evidence for Cannabis' Role in Opioid Use Disorder

Wiese

Wilson-Poe

2018

Cannabis and Cannabinoid Research

127

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“…Future research should be reoriented to focus on this specific behavior both as a potential marker for persistent vulnerability to relapse and as a potential target for the development of potential relapse prevention interventions. The failure to target and eradicate this behavior may explain, at least partly, why preclinical research has so far been unable to deliver clinically-effective relapse prevention interventions in cocaine addiction 45,46 .…”

Section: Discussionmentioning

confidence: 99%

Persistent vulnerability to relapse despite complete extinction of cocaine craving

Girardeau

Navailles

Durand

et al. 2016

Preprint

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Craving often precedes relapse into cocaine addiction. This explains why considerable research effort is being expended to try to develop anti-craving strategies for relapse prevention. Recently, we discovered using the classic reinstatement model of cocaine craving that the reinstating or priming effect of cocaine can be extinguished with repeated priming in rats -a phenomenon dubbed extinction of cocaine priming. Here we sought to measure the potential beneficial effect of this novel extinction strategy on subsequent relapse (i.e., return to the pre-extinction pattern of cocaine self-administration once the drug is made again available after extinction). Overall and contrary to our initial hope, extensive and complete extinction of cocaine priming had no major impact on relapse. This lack of effect occurred despite evidence for post-extinction loss of neuronal responses to cocaine priming in brain regions critically involved in cocaine-induced reinstatement (i.e., the dorsomedial prefrontal cortex and the core of the nucleus accumbens). An effect of extinction of cocaine priming on relapse was only observed when cocaine was available for self-administration under more demanding conditions. However, this effect was modest and short-lived. Finally, we succeeded to trace the origin of our failure to prevent relapse to a persistent, extinctionresistant form of operant behavior that is not directly induced by cocaine. This extinctionresistant behavior is commonly reported, though generally ignored as causally irrelevant, in many other reinstatement studies. We propose that this behavior should become both a novel marker for long-term vulnerability to relapse and a novel target for preclinical development of potential relapse prevention interventions.Cocaine not only evokes intense pleasurable sensations but also induces an overwhelming desire or craving for more cocaine. This latter process is especially obvious in individuals with a diagnosis of cocaine use disorder and is thought to contribute, together with other factors, to precipitate or favor relapse after abstinence 1, 2, 3 . Cocaine-induced craving can be approached and studied in animals using the classic drug reinstatement model 4, 5 . In this model, operant responding for the drug (e.g., pressing a lever) is first extinguished by discontinuing drug reinforcement and then reinstated by drug priming (i.e., passive or noncontingent drug administration). Importantly, after drug priming, reinstated operant responding continues to be non-reinforced as during extinction and, therefore, is thought to be a behavioral expression of genuine drug seeking 6, 7 . This standard model has been extensively used to study the neural correlates and substrates of cocaine seeking and to develop potential anti-craving interventions for relapse prevention 8,9,10 .Using this model, we recently discovered that the reinstating effect of cocaine on previously extinguished cocaine seeking can itself be extinguished with repeated drug priming -a phenomenon dubbed extinction of drug pr...

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“…The underlying mechanisms that enable stress-sensitive and dysphoric states in withdrawal to induce relapse are thought to involve alterations to the mesolimbic dopamine reward system and anti-reward/stress systems [9,26,28] that include the hippocampus [28][29][30]. Currently, no medications have proven effective for treating psychostimulant withdrawal [13,16,31]. Thus, understanding the neurobiology underlying the aversive states during psychostimulant withdrawal is an essential component of relapse prevention [32].…”

Section: The Problem Of Stimulant Abusementioning

confidence: 99%

The Hippocampus as a Neural Link between Negative Affect and Vulnerability for Psychostimulant Relapse

Barr¹,

Bray²,

Forster³

2018

The Hippocampus - Plasticity and Functions

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Psychostimulant dependence (including cocaine, amphetamine, and methamphetamine) is a chronic relapsing disorder with significant personal, health, and financial burdens. Attempts at abstinence produce a severe and protracted withdrawal syndrome characterized by stress hypersensitivity that can facilitate drug craving, anxiety, and dysphoria. These negative withdrawal symptoms can induce relapse, maintaining the addiction cycle. The hippocampus mediates cognitive, emotional, and endocrine responses to stressors. The ventral hippocampus is in a pivotal position to regulate the mesoaccumbal dopamine reward system, and interacts with serotonergic and glucocorticoid systems that mediate anxiety and stress responsiveness. Psychostimulant actions on the hippocampus induce long-term changes to these systems and impact the process of adult neurogenesis in the hippocampus, which may facilitate drug dependence by altering drug-cue learning and emotional regulation. Multiple studies indicate that psychostimulant-induced hippocampal neuroadaptations heighten hippocampal-mesoaccumbal activity to amplify drug-and drug-cue responses while persistent dysregulation of hippocampal emotional systems potentiate negative affect. Understanding how psychostimulants modulate the hippocampus to alter hippocampal-mesoaccumbal activity-and how hippocampal neurogenesis influences drug-related memories and reward-is important for identifying novel treatment strategies that can ameliorate negative affect and relapse vulnerability in psychostimulant addiction.

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Pharmacological treatments for drug misuse and dependence

Cited by 17 publications

References 40 publications

Emerging Evidence for Cannabis' Role in Opioid Use Disorder

Emerging Evidence for Cannabis' Role in Opioid Use Disorder

Persistent vulnerability to relapse despite complete extinction of cocaine craving

The Hippocampus as a Neural Link between Negative Affect and Vulnerability for Psychostimulant Relapse

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