Addiction Medicine

Liquid Fear Antagonist

Alcohol reduces the connection between the amygdala and the prefrontal cortex, so the fear and smart centres don’t communicate as much.

Research people did an experiment, as they often claim to do. It was a suspiciously small sample of participants, as it often is. The difference here was the humanoid laboratory rats being drunk on almost half a litre of alcohol. In fMRI, there was reduced amygdala to prefrontal cortex activity during alcohol intoxication. This suggests reduced connectivity.

Specifically, the decreased amygdala to orbitofrontal cortex interaction messes up the processing and behavioural inhibition around emotional stimuli.

References

  1. Gorka, S. M., Fitzgerald, D. A., King, A. C., & Phan, K. L. (2013). Alcohol attenuates amygdala-frontal connectivity during processing social signals in heavy social drinkers: a preliminary pharmaco-fMRI study. Psychopharmacology, 229(1), 141–154. https://doi.org/10.1007/s00213-013-3090-0
  2. Rolls, E. T., Cheng, W., & Feng, J. (2020). The orbitofrontal cortex: reward, emotion and depression. Brain communications, 2(2), fcaa196. https://doi.org/10.1093/braincomms/fcaa196

Methadone Versus Suboxone

The major treatment for opioid dependence is opioid replacement therapy.

Two big options exist. Both are given daily under observation.

Methadone

  • Only opioid agonist activity, not antagonist
    • Can be dangerous if IVDU while on methadone
  • Works in special groups
    • Mental health
      • Safe in mental health issues, like schizophrenia
    • Pregnant
      • Not teratogenic
    • Homeless
      • As have more chaotic lifestyle
  • Longer half-life
    • Increase dose more slowly, such after 4 days

Suboxone

  • Combined partial opioid agonist and antagonist
    • Buprenorphine plus naloxone
  • First-line in normal situations
    • Given methadone in pregnancy
      • Buprenorphine has no studies on safety
      • Naloxone is teratogenic
    • Suboxone is considered weaker than methadone
  • Given sublingually
    • So goes to blood
    • Not effective if taken orally through gastrointestinal system
    • Naloxone works as antagonist in blood, not gut
    • Thus, is good if IVDU patient
  • Can increase dose every day, such as after 24 hours

References

  • Doctor from Centre For Addiction Medicine