Naloxone challenge in smokers. Preliminary evidence of an opioid component in nicotine dependence.
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.


CONCLUSIONS
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.
Department of Psychiatry, Yale University School of Medicine, New Haven, Conn., USA.
S
S
Krishnan-Sarin
M I
MI
Rosen
S S
SS
O'Malley
D000328:Adult; D016739:Behavior, Addictive / Q000523:psychology*; D004723:Endorphins / Q000502:physiology*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D009270:Naloxone / Q000494:pharmacology / Q000627:therapeutic use; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000209:etiology; D014029:Tobacco Use Disorder / Q000175:diagnosis* / Q000503:physiopathology / Q000517:prevention & control
D004723:Endorphins; D009270:Naloxone; D006854:Hydrocortisone