Pharmacotherapeutic management of co-morbid alcohol and opioid use

ABSTRACT

Opioid use disorder (OUD) and alcohol use disorder (AUD) are two highly prevalent substance-related disorders worldwide. Co-use of the substances is also quite prevalent, yet there are no pharmacological treatment approaches specifically designed to treat co-morbid OUD and AUD. Here, the authors critically summarize OUD, AUD and opioid/alcohol co-use and their current pharmacotherapies for treatment. They also review the mechanisms of action of opioids and alcohol within the brain reward circuitry and discuss potential combined mechanisms of action and resulting neuroadaptations. Pharmacotherapies that aim to treat AUD or OUD that may be beneficial in the treatment of co-use are also highlighted. Preclinical models assessing alcohol and opioid co-use remain sparse. Lasting neuroadaptations in brain reward circuits caused by co-use of alcohol and opioids remains largely understudied. In order to fully understand the neurobiological underpinnings of alcohol and opioid co-use and develop efficacious pharmacotherapies, the preclinical field must expand its current experimental paradigms of ‘single drug’ use to encompass polysubstance use. Such studies will provide insights on the neural alterations induced by opioid and alcohol co-use, and may help develop novel pharmacotherapies for individuals with co-occurring alcohol and opioid use disorders.

KEYWORDS:

• Alcohol
• AUD
• co-use
• co-morbidity
• opioid
• opiate
• OUD
• pharmacotherapies

Article highlights

• The misuse of prescription opioids is heavily correlated with alcohol abuse, where binge alcohol drinkers are twice as likely to abuse prescription opioids than non-alcohol drinkers.

• The co-morbidity of alcohol use disorder (AUD) and opioid use disorder (OUD) is becoming more prevalent within the United States.

• While neuroadaptations induced by alcohol and opioids have been studied separately, changes observed within the brain reward circuitry overlap substantially between the two drugs.

• Pharmacotherapies used to treat AUD and OUD elicit their therapeutic effects by acting on the same receptors and physiological pathways.

• Treatment development for polysubstance is lacking, in part due to limitations in preclinical polysubstance abuse models.

• The evaluation of preclinical findings in combination with successful clinical pharmacotherapies has the ability to advance the current understanding of OUD and AUD and lend insight into treatment options for individuals suffering from alcohol and opioid polysubstance use.

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Declaration of Interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was supported by Public Health Service grants DA042172, AA025590 and AA027962 from the National Institutes of Health.