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Naloxone Challenge in Smokers
Preliminary Evidence of an Opioid Component in Nicotine Dependence
Suchitra Krishnan-Sarin, PhD;
Marc I. Rosen, MD;
Stephanie S. O'Malley, PhD
Arch Gen Psychiatry. 1999;56:663-668.
Background This study used an opioid antagonist challenge procedure to evaluate the responsivity of the endogenous opioid system in nicotine-dependent individuals, as evidenced by naloxone-induced alterations in both behavioral (withdrawal, craving) and neuroendocrine (cortisol levels) parameters.
Methods Twenty subjects (9 smokers and 11 nonsmokers) participated in 4 laboratory sessions during which they were challenged with 0, 0.8, 1.6, or 3.2 mg/70 kg of naloxone and then monitored for 1 hour for subjective signs and symptoms of opiate-like withdrawal, nicotine craving, and alterations in cortisol levels.
Results Nicotine-dependent subjects evidenced naloxone dose-dependent increases in withdrawal signs and symptoms. Lower doses of naloxone also produced increases in urges to smoke (craving) and tiredness in smokers. Smokers, when compared with nonsmokers, had lower prenaloxone baseline levels of cortisol and attenuated cortisol release in response to challenge with naloxone.
Conclusion These results provide preliminary evidence to suggest that long-term exposure to cigarette smoke is associated with alterations in the responsivity of the endogenous opioid system and the hypothalamic-pituitary-adrenal axis that may contribute to the development of nicotine dependence.
From the Department of Psychiatry (Dr Krishnan-Sarin) Yale University School of Medicine, New Haven, Conn; The Substance Abuse Treatment Unit (Drs Krishnan-Sarin and O'Malley) and the Veterans Medical Center (Dr Rosen) West Haven, Conn.
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