Pharmacotherapy of Opioid Use Disorder—Update and Current Challenges

Racha, Savitha; Buresh, Megan; Fingerhood, Michael

doi:10.1016/j.psc.2022.04.001

Cited by 5 publications

(3 citation statements)

References 46 publications

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“…Patients on naltrexone will also have no reaction to typical opioid dosages. Patients in excruciating pain may require additional interventions, including high doses of opioids, regional or general anaesthesia, or both (29) .…”

Section: Patient' Selectionmentioning

confidence: 99%

Brief Overview about Opioid Use Disorder: Review Article

Mahdy,

Hashem,

Hefny

et al. 2023

The Egyptian Journal of Hospital Medicine

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Background: Recurrent opioid usage despite negative consequences is a hallmark of opioid use disorder. There are about 16 million people with an opioid use disorder worldwide, including over 2.1 million in the United States; annually, opioids cause over 120,000 deaths. When visiting Egypt several epidemiological studies on drug abuse in Egypt were conducted in the past few decades. 5.5% of high school students tested positive for cannabis use, while 0.84% tested positive for opiate use. Objective: Review of literature about opioid use disorder. Methods: We scoured scholarly papers and databases including PubMed, Google Scholar, and Science Direct for information on Opioid Use Disorder (OUD) between July 2013 and September 2022, however, only the latest or most comprehensive study was considered. The authors also assessed the usefulness of references taken from similar books. Documents written in languages other than English have been overlooked because of a lack of funding to translate them. Unpublished articles, oral talks, conference abstracts, and dissertations were all generally agreed upon not to constitute valid scientific investigation. Conclusion: Addiction of opioids is characterized by compulsive opioid seeking and use, impaired self-control regarding drug intake, and the emergence of negative effective symptoms (hyperkatifeia) in the presence of drug absence. The binge/intoxication phase of substance abuse initiates an allostatic chain reaction that results in the subsequent withdrawal/negative affect phase and the preoccupation/anticipation phase. With continued drug use, each stage builds on the previous ones until addiction has set in. Medical intervention is used to treat opioid withdrawal symptoms (OWS). Opioid agonist therapy (OAT) is the gold standard for relieving OWS in individuals with moderate to severe OUD.

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Section: Patient' Selectionmentioning

confidence: 99%

Brief Overview about Opioid Use Disorder: Review Article

Mahdy,

Hashem,

Hefny

et al. 2023

The Egyptian Journal of Hospital Medicine

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“…Over-activation of opioidergic neurotransmission during chronic opioid misuse leads to negative motivational effects associated with opioid tolerance, dependence, and withdrawal (Bodnar, 2019), essential aspects of opioid use disorder (OUD). The opioid receptor agents buprenorphine, methadone, and naltrexone are used to treat OUD (Racha, Buresh and Fingerhood, 2022). Methadone is an agonist of the µ opioid receptor that acts primarily as a ‘replacement therapy’ for illicit opioids that reduces the effects of opioid withdrawal and opioid craving, although not the acute reinforcing effects of heroin (Donny et al ., 2002).…”

Section: Introductionmentioning

confidence: 99%

Opioid receptor antagonists reduce motivated wheel-running behavior in mice

Kitanaka,

Arai,

Takehara

et al. 2024

Behavioural Pharmacology

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We hypothesized that opioid receptor antagonists would inhibit motivated behavior produced by a natural reward. To evaluate motivated responses to a natural reward, mice were given access to running wheels for 71.5 h in a multi-configuration testing apparatus. In addition to a running wheel activity, locomotor activity (outside of the wheel), food and water intake, and access to a food container were measured in the apparatus. Mice were also tested separately for novel-object exploration to investigate whether naloxone affects behavior unrelated to natural reward. In untreated mice wheel running increased from day 1 to day 3. The selective µ-opioid receptor antagonist β-funaltrexamine (β-FNA) (5 mg/kg) slightly decreased wheel running, but did not affect the increase in wheel running from day 1 to day 3. The non-selective opioid receptor antagonist naloxone produced a greater reduction in wheel running than β-FNA and eliminated the increase in wheel running that occurred over time in the other groups. Analysis of food access, locomotor behavior, and behavior in the novel-object test suggested that the reduction in wheel running was selective for this highly reinforcing behavior. These results indicate that opioid receptor antagonism reduces responses to the natural rewarding effects of wheel running and that these effects involve multiple opioid receptors since the non-selective opioid receptor antagonist had greater effects than the selective µ-opioid receptor antagonist. It is possible that at the doses employed, other receptor systems than opioid receptors might be involved, at least in part, in the effect of naloxone and β-FNA.

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“…NTX is available as daily oral tablets or a monthly depot injection, both of which have challenges for chronic dosing scenarios. 2 These challenges include extensive and highly variable first pass metabolism (5–40%) and hepatotoxicity associated with the oral dosage form, and the high cost and inconvenience of the injectable depot. Transdermal NTX delivery could provide distinct advantages, including more consistent plasma concentrations and potential for self-administration.…”

Section: Introductionmentioning

confidence: 99%