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Non-Opioid Treatments for Opioid Use Disorder: Rationales and Data to Date

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Abstract

Opioid use disorder (OUD) represents a major public health problem that affects millions of people in the USA and worldwide. The relapsing and recurring aspect of OUD, driven by lasting neurobiological adaptations at different reward centres in the brain, represents a major obstacle towards successful long-term remission from opioid use. Currently, three drugs that modulate the function of the opioidergic receptors, methadone, buprenorphine and naltrexone have been approved by the US Food and Drug Administration (FDA) to treat OUD. In this review, we discuss the limitations and challenges associated with the current maintenance and medication-assisted withdrawal strategies commonly used to treat OUD. We further explore the involvement of glutamatergic, endocannabinoid and orexin signaling systems in the development, maintenance and expression of addiction-like behaviours in animal models of opioid addiction, and as potential and novel targets to expand therapeutic options to treat OUD. Despite a growing preclinical literature highlighting the role of these potential targets in animal models of opioid addiction, clinical and translational studies for novel treatments of OUD remain limited and inconclusive. Further preclinical and clinical investigations are needed to expand the arsenal of primary treatment options and adjuncts to maximise efficacy and prevent relapse.

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Authors and Affiliations

  1. Department of Neuroscience, Medical University of South Carolina, Charleston, SC, USA

    Reda M. Chalhoub & Peter W. Kalivas

  2. Medical Student Training Program, Medical University of South Carolina, Charleston, SC, USA

    Reda M. Chalhoub

Authors
  1. Reda M. Chalhoub
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  2. Peter W. Kalivas
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Corresponding author

Correspondence to Peter W. Kalivas.

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Funding

This work was completed with funding supported from the National Institute of Drug Abuse (NIDA), 5T32 DA7288-28 (RMC) and 2RO1 DA003906-37, 1 P50 DA046373-01, 1U01 DA04530001A1 (PWK), and a VA Merit Award BX004727 (PWK).

Conflict of interest

Peter Kalivas and Reda Chalhoub have no conflicts of interest to disclose.

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Chalhoub, R.M., Kalivas, P.W. Non-Opioid Treatments for Opioid Use Disorder: Rationales and Data to Date. Drugs 80, 1509–1524 (2020). https://doi.org/10.1007/s40265-020-01373-1

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