Naltrexone Implant for Opioid Use Disorder

The continued rise in the availability of illicit opioids and opioid-related deaths in the United States has left physicians, researchers, and lawmakers desperate for solutions to this ongoing epidemic. The research into therapeutic options for the treatment of opioid use disorder (OUD) began with the introduction of methadone in the 1960s. The approval of oral naltrexone initially showed much promise, as the drug was observed to be highly potent in antagonizing the effects of opioids while producing no opioid agonist effects of its own and having a favorable side effect profile. Patients that routinely take their naltrexone reported fewer days of heroin use and had more negative drug tests than those without treatment. Poor outcomes in OUD patients treated with naltrexone have been directly tied to short treatment time. Studies have shown that naltrexone given orally vs. as an implant at the 6-month interval showed a higher non-compliance rate among those who used oral medications at the 6-month mark and a slower return to use rate. There were concerns that naltrexone could possibly worsen negative symptoms seen in opiate use disorder related to blockade of endogenous opioids that are important for pleasurable stimuli. Studies have shown that naltrexone demonstrated no increase in levels of anxiety, depression and anhedonia in participants and another study found that those treated with naltrexone had a significant reduction in mental health-related hospitalizations. The latter study also concluded that there was no increased risk for mental health-related incidents in patients taking naltrexone via a long-acting implant. Although not yet FDA approved in the United States, naltrexone implant has shown promising results in Europe and Australia and may provide a novel treatment option for opioid addiction.

Opioid withdrawal abruptly disrupts amygdala circuit function by reducing peptide actions

Opioid withdrawal drives relapse and contributes to compulsive drug use through disruption of endogenous opioid dependent learning circuits in the amygdala. Normally, endogenous opioids control these circuits by inhibiting glutamate release from basolateral amygdala principal neurons onto GABAergic intercalated cells. Using patch-clamp electrophysiology in rat brain slices, we reveal that opioid withdrawal dials down this endogenous opioid inhibition of synaptic transmission. Peptide activity is dialled down due to a protein kinase A dependent increase in the activity of the peptidase, neprilysin. This disrupts peptidergic control of both GABAergic and glutamatergic transmission through multiple amygdala circuits, including reward-related outputs to the nucleus accumbens. This likely disrupts peptide-dependent learning processes in the amygdala during withdrawal. and may direct behaviour towards compulsive drug use. Restoration of endogenous peptide activity during withdrawal may be a viable option to normalise synaptic transmission in the amygdala and restore normal reward learning.

The Role of Beta-Endorphin in Cocaine-Induced Conditioned Place Preference, Its Extinction, and Reinstatement in Male and Female Mice

Endogenous opioids have been implicated in cocaine reward. However, the role of each opioid peptide in this regard is unknown. Notably, the role of each peptide in extinction and reinstatement is not fully characterized. Thus, we assessed whether cocaine-induced conditioned place preference (CPP) and its extinction and reinstatement would be altered in the absence of beta-endorphin. We also examined if sex-related differences would exist in these processes. Male and female mice lacking beta-endorphin and their respective controls were tested for baseline place preference on day 1. On day 2, mice were treated with saline/cocaine (15 mg/kg) and confined to the vehicle- or drug-paired chamber for 30 min, respectively. In the afternoon, mice were treated with the alternate treatment and confined to the opposite chamber. Mice were then tested for CPP on day 3. Mice then received additional conditioning on this day as well as on day 4. Mice were then tested for CPP on day 5. Mice then received extinction training on day 9. On day 10, mice were tested for extinction and then reinstatement of CPP following a priming dose of cocaine (7.5 mg/kg). Male and female mice lacking beta-endorphin did not exhibit CPP following single conditioning with cocaine. On the other hand, only male mice lacking beta-endorphin failed to show CPP after repeated conditioning. Nonetheless, reinstatement of CPP was blunted in both male and female mice lacking beta-endorphin compared to controls. The present results suggest that beta-endorphin plays a functional role in cocaine-induced CPP and its reinstatement, and sex-related differences exist in the regulatory action of beta-endorphin on the acquisition but not reinstatement of cocaine CPP.

The Expression Pattern of Genes Related to Melanogenesis and Endogenous Opioids in Psoriasis

The melanocortin system is a major regulator of stress responses in the skin and is responsible for the induction of melanin synthesis through activation of melanogenesis enzymes. The expression of both melanocortin system genes and melanogenesis enzyme genes is altered in psoriasis, and the focus here was on twelve genes related to the signal transduction between them. Additionally, five endogenous opioid system genes that are involved in cutaneous inflammation were examined. Quantitative real-time-PCR was utilized to measure mRNA expression in punch biopsies from lesional and non-lesional skin of psoriasis patients and from the skin of healthy control subjects. Most of the genes related to melanogenesis were down-regulated in patients (CREB1, MITF, LEF1, USF1, MAPK14, ICAM1, PIK3CB, RPS6KB1, KIT, and ATRN). Conversely, an up-regulation occurred in the case of opioids (PENK, PDYN, and PNOC). The suppression of genes related to melanogenesis is in agreement with the reported reduction in pigmentation signaling in psoriatic skin and potentially results from the pro-inflammatory environment. The increase in endogenous opioids can be associated with their involvement in inflammatory dysregulation in psoriasis.

Scene Preferences, Aesthetic Appeal, and Curiosity

A gradient of µ-opioid receptors extends from early sensory areas of the cerebral cortex to associative cortex, with the greatest density of receptors in the most anterior associative regions. In 2006, Biederman and Vessel proposed that the hedonic value of perceptual and cognitive experience is a function of activation of this gradient. A desire for opioid activity provided by this gradient renders us infovores, always seeking novel but richly interpretable experiences. Richly interpretable experiences engage the opioid-dense anterior regions of the gradient, while novel experiences engage neural ensembles that have yet to undergo adaptation. Support for this proposal derives from the greater activity elicited in opioid-rich parahippocampal cortex for preferred over nonpreferred scenes, with neural network modeling of visual aesthetic responses suggesting that representations in later stages are more predictive of aesthetic responses, and psychopharmacological experiments that support the potential involvement of endogenous opioids.

Why Does Music Evoke Strong Emotions?

Although much is known about the brain mechanisms underlying music perception and cognition, there is much work to be done in understanding aesthetic responses to music: Why does music make us feel the way we do? Why does it make us feel anything? In the article under discussion, the authors suggest that the brain’s own endogenous opioids mediate musical emotion, using the hypothesis of naltrexone-induced musical anhedonia. They conclude that endogenous opioids are critical to experiencing both positive and negative emotions in music and that music uses the same reward pathways as food, drugs, and sexual pleasure. Their findings add to the growing body of evidence for the evolutionary biological substrates of music.

Different brain systems support the aversive and appetitive sides of human pain-avoidance learning

Both unexpected pain and unexpected pain absence can drive avoidance learning, but whether they do so via shared or separate neural and neurochemical systems is largely unknown. To address this issue, we combined an instrumental pain-avoidance learning task with computational modeling, functional magnetic resonance imaging (fMRI) and pharmacological manipulations of the dopaminergic (100 mg levodopa) and opioidergic (50 mg naltrexone) systems (N=83). Computational modeling provided evidence that untreated participants learned more from received than avoided pain. Our dopamine and opioid manipulations negated this learning asymmetry by selectively increasing learning rates for avoided pain. Furthermore, our fMRI analyses revealed that pain prediction errors were encoded in subcortical and limbic brain regions, whereas no-pain prediction errors were encoded in frontal and parietal cortical regions. However, we found no effects of our pharmacological manipulations on the neural encoding of prediction errors. Together, our results suggest that human pain-avoidance learning is supported by separate threat- and safety-learning systems, and that dopamine and endogenous opioids specifically regulate learning from successfully avoided pain.

Zsigeri fájdalom, nocebo-hatások, placebo-analgézia

Összefoglaló. A belső szervek működési zavarai gyakran származnak viselkedési, lelki vagy pszichoszociális okokból, amelyeknek nem mindig vagyunk tudatában. Minthogy ebben a folyamatban egy bonyolult neuronális hálózat játssza a fő szerepet, ezeknek a zavaroknak a diagnózisa és terápiája számos tényező manipulálását igényli. A funkcionális gyomor-bélhuzam rendellenességek (FGID), például az irritábilisbél-szindróma (IBS), jellemző példái ennek: olyan működési zavarokról van szó, amelyek mögött jól detektálható szervi vagy biokémiai elváltozásokat nem találnak. Ilyenkor szükségesnek tűnik a komplex megközelítés, amely többféle szakember együttműködését kívánja meg. Szerepe lehet a pszichés vagy életmód terápiának, a gyógyszeres és fizikai kezelésnek is, és – ahogy ebben a cikkben megmutatjuk – a placebo-terápiának is. Summary. Functional disorders of the internal organs frequently are results of behavioral, mental or psycho-social dysfunctions, although we are usually not conscious about it. A typical example isirritable bowel syndrome (IBS), a characteristic functional gastro-intestinal disorder (FGID), which is regularly accompanied by abdominal pain and irregular intestinal motility and defecation. It has been shown that this disorder cannot be due to a single factor, nor is it a result of a local cause. Recently researchers have proven that malfunction of a complicated neuronal network, including several brain sites, may be responsible for IBS. It is believed now that IBS is the consequence of several nocebo-effects. IBS is a typical source of visceral pain or discomfort, a source that is frequently difficult to identify. Main factors are stimuli originating from the gastro-intestinal tract, passing through the spinal cord and reaching several brain structures, including cortical and sub-cortical sites. It has been shown that some structures become thicker while others thinner as a result of lasting visceral pain, resulting in altered top-down effects on the visceral organs. Several hormones accompany these processes resulting in a complicated network activity. Recent research has revealed that IBS requires a complex approach, optimally provided by a therapeutic team of physicians, psychologist/psychiatrist, associates, and even the patient himself/herself. They may apply or suggest medicines, physiotherapy, lifestyle modifications, alimentary changes etc. An important feature is that the nocebo-effect plays an important role in the generation of IBS, thus one may think the opposite phenomenon, placebo-effect could be used in the therapeutic process. And really, placebo-analgesia is a method frequently used in the therapy of IBS. Placebo-analgesia affects brain processes, including pain processing, release of hormones, including endogenous opioids, the primary pain-decreasing factors. A top-down pain-modification system exists which can be affected and activated by the placebo-analgesia thus counteracting the nocebo-effects and improving the condition of the individual. The placebo phenomenon is interesting in itself, too. By now, the major question is not the existence of the placebo-effect but the mechanisms behind it. Recently, as brain-mapping techniques have gained their role in research, a lot of new information proves that the placebo-effect (as well as the nocebo-effect) is a complex phenomenon that involves several different brain sites, including the brain cortex and the limbic system, respectively.P The placebo-effect is widely used in clinical practice, first of all as a reference treatment when new drugs or medicines are tested for their effectivity. There are numerous ethical problems in this area, recently, for example, when testing Covid-19 vaccines. The main problem is whether it is legal to keep a non-treated population, whether the placebo-group should be treated immediately after the trial ends, whether the members of the placebo-group should get adequate information.

Yoga as an Adjunct for Management of Opioid Dependence Syndrome: A Nine-Month Follow-Up Case Report

Opioid dependence syndrome (ODS) is a chronic relapsing remitting condition associated with significant impairment and mortality risk. Opioid substitution therapy is used worldwide, but long-term retention rates are low and there is risk of misuse and diversion. Yoga practice can improve quality of life, reduce chronic pain, and enhance endogenous opioids (beta-endorphins). We describe a case of ODS where yoga was added to the conventional management and who was followed up for 9 months. Assessments were done for clinical symptoms, urine drug screening, plasma beta-endorphins, and Buprenorphine dosage. We observed an improvement in his clinical symptoms and reduction in the requirements for Buprenorphine. A slight increase in basal plasma beta-endorphin levels was also observed at the 9-month follow-up (from 2.02 pmol/L at baseline to 6.51 pmol/L).