What if Oxy were less addictive? Is there a pill for that?

[drusso]

Analgesic Effects of Oxycodone in Combination With Risperidone or Ziprasidone: Results From a Pilot Randomized Controlled Trial in Healthy Volunteers

Ameet S. Nagpal1, Daniel J. Lodge2, Jennifer S. Potter3, Alan Frazer2, Robin Tragus4, Megan E. Curtis3,5, Angela M. Boley2* and Maxim Eckmann1
1Department of Anesthesiology, UT Health San Antonio, San Antonio, TX, United States
2Department of Pharmacology, UT Health San Antonio, San Antonio, TX, United States
3Department of Psychiatry, UT Health San Antonio, San Antonio, TX, United States
4Department of Pediatrics, UT Health San Antonio, San Antonio, TX, United States
5Department of Psychology, University of Texas at San Antonio, San Antonio, TX, United States

Background and Objectives: Patients taking opioids are at risk of developing dependence and possibly abuse. Given the role of the mesolimbic dopamine system in opioid reward, blocking dopamine D2 receptors should limit the abuse liability of opioid analgesics. This pilot study evaluates the analgesic efficacy of oxycodone combined with an atypical antipsychotic (dopamine D2 receptor antagonist).

Methods: A randomized, double-blind, within-subjects, controlled trial in healthy volunteers was conducted at UT Health SA Pain Clinic. Fifteen volunteers with previous medical exposure to opioids were enrolled. Risperidone (2 mg) or ziprasidone (80 mg) in combination with oxycodone (5, 10, 15 mg) was administered. Pain intensity using the cold pressor test, Current Opioid Misuse Measure (COMM), Addiction Research Center Inventory (ARCI, opioid subscale), Drug likability with drug effects questionnaire (DEQ) were assessed.

Results: Oxycodone produced dose dependent increases in thermal analgesia on the cold pressor test that was significant at 10 and 15 mg (t = 3.087, P = 0.017). The combination did not significantly alter thermal analgesia. There was no significant effect of the combination on the ARCI or the POMS.

Discussion and Conclusion: The combination of an atypical antipsychotic with oxycodone does not alter analgesic response or increase the incidence of adverse effects when compared to oxycodone alone. Such information is critical for the development of drug combinations for the treatment of pain and provide the foundation for future studies of abuse potential in drug users.

Scientific Significance: This intervention in chronic pain patients is unique because it utilizes FDA approved drugs in combination to reduce abuse liability. The first step, and aim of this study, is to confirm the drug combination does not interfere with analgesic efficacy. The next step is to examine the combination in recreational drug users to assess the potential to block the euphoric effects of oxycodone. Ultimately, if this combination is effective, this approach could be beneficial in management of chronic pain.

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[au bon pain]

"Sorry doc, I'm allergic. Risperidone/ziprasidone makes me blind. But I appreciate you offering me a real pain med, to keep things safe just write oxy straight up."

 

[pmrmd]

Eh. Not using dopamine blockers in patients that don’t hear voices.

 

[RoloTomassi]

"I know you don't want to switch up your regimen, but let's try this new drug. Just watch out for involuntary movements, lactation, and a fever that can kill you."

 

[Orin]

Eh. Not using dopamine blockers in patients that don’t hear voices.

Wait, voices aren't normal? Damn....

 

[lobelsteve]

Wait, voices aren't normal? Damn....

Depends what they are saying.

 

[lobelsteve]

It's the person not the drug.

 

[MitchLevi]

An opiate mixed with an antipsychotic?

Why not just give the regular opiate after you've properly screened the pt?

 

[Agast]

My patient told me, “When I was in the Recovery Room, they gave me an OxyContin…it was amazing, I felt soooo relaxed and wonderful. And when I went home, I didn’t care that I was working for [job she acts like is stressful but doesn’t sound that bad to me]. So I would like to have OxyContin for my pain instead of tramadol.”

It was oxycodone 5/325mg…

I told her, “Ma’am - what you described was Euphoria. That is what makes these medications addictive. If anything, it means you should not be given this medication again. Basically it made you high.”

Patient: “No it wasn’t a high! I just felt really great”

And then I had to scold a woman in her 60’s who was trying to start a drug addiction.

 

[Tramadeezy]

Maybe she needed some love in her life. Interesting take on addiction…

 

[deleted875186]

My patient told me, “When I was in the Recovery Room, they gave me an OxyContin…it was amazing, I felt soooo relaxed and wonderful. And when I went home, I didn’t care that I was working for [job she acts like is stressful but doesn’t sound that bad to me]. So I would like to have OxyContin for my pain instead of tramadol.”

It was oxycodone 5/325mg…

I told her, “Ma’am - what you described was Euphoria. That is what makes these medications addictive. If anything, it means you should not be given this medication again. Basically it made you high.”

Patient: “No it wasn’t a high! I just felt really great”

And then I had to scold a woman in her 60’s who was trying to start a drug addiction.

Yes. I say the same thing to people who come on oxycodone or some other strong opioid, I ask does it help, they tell me it makes them feel good for a couple hours …

To be honest, I feel like these people are surprised when I ask “did the opioid you took help any of your pain”.

 

[deleted875186]

It's the person not the drug.

While I agree with this, there are still people who will get addicted that we cannot predict with any amount of screening, even with appropriate prescribing. I think the efforts to make abuse deterrent opioids is a very worthwhile effort.

 

[lobelsteve]

My patient told me, “When I was in the Recovery Room, they gave me an OxyContin…it was amazing, I felt soooo relaxed and wonderful. And when I went home, I didn’t care that I was working for [job she acts like is stressful but doesn’t sound that bad to me]. So I would like to have OxyContin for my pain instead of tramadol.”

It was oxycodone 5/325mg…

I told her, “Ma’am - what you described was Euphoria. That is what makes these medications addictive. If anything, it means you should not be given this medication again. Basically it made you high.”

Patient: “No it wasn’t a high! I just felt really great”

And then I had to scold a woman in her 60’s who was trying to start a drug addiction.

Let's hear about her ORT, DIRE, and SOAPP-R.

At 60, I'm certain we can tease out a few risk factors.

 

[Ducttape]

the authors make a statement about how respiridone may decrease abuse but nothing in this article looks at that aspect.

also, dependence =/= abuse


it is a very limited study that only implies that using respiridone doesnt affect oxycodone on thermal pain. nothing else.

 

[drusso]

the authors make a statement about how respiridone may decrease abuse but nothing in this article looks at that aspect.

also, dependence =/= abuse


it is a very limited study that only implies that using respiridone doesnt affect oxycodone on thermal pain. nothing else.

The goal is to make Oxy less addictive.

 

[Ducttape]

they didnt advance that goal. only that respiridone didnt alter oxy effects.

 

[drusso]

they didnt advance that goal. only that respiridone didnt alter oxy effects.

Read the discussion section. The KOL on the study is very focused on this outcome.