Division on Substance Abuse, New York State Psychiatric Institute and Department of Psychiatry, Columbia University Medical Center, New York, NY, 10032, USA.
Orygen National Centre of Excellence in Youth Mental Health, and Center for Youth Mental Health, University of Melbourne, Melbourne, Australia.
Neuropsychopharmacology. 2018 Sep;43(10):2046-2055. doi: 10.1038/s41386-018-0011-2. Epub 2018 Feb 5.
Cannabinoids combined with opioids produce synergistic antinociceptive effects, decreasing the lowest effective antinociceptive opioid dose (i.e., opioid-sparing effects) in laboratory animals. Although pain patients report greater analgesia when cannabis is used with opioids, no placebo-controlled studies have assessed the direct effects of opioids combined with cannabis in humans or the impact of the combination on abuse liability. This double-blind, placebo-controlled, within-subject study determined if cannabis enhances the analgesic effects of low dose oxycodone using a validated experimental model of pain and its effects on abuse liability. Healthy cannabis smokers (N = 18) were administered oxycodone (0, 2.5, and 5.0 mg, PO) with smoked cannabis (0.0, 5.6% Δ tetrahydrocannabinol [THC]) and analgesia was assessed using the Cold-Pressor Test (CPT). Participants immersed their hand in cold water (4 °C); times to report pain (pain threshold) and withdraw the hand from the water (pain tolerance) were recorded. Abuse-related effects were measured and effects of oxycodone on cannabis self-administration were determined. Alone, 5.0 mg oxycodone increased pain threshold and tolerance (p ≤ 0.05). Although active cannabis and 2.5 mg oxycodone alone failed to elicit analgesia, combined they increased pain threshold and tolerance (p ≤ 0.05). Oxycodone did not increase subjective ratings associated with cannabis abuse, nor did it increase cannabis self-administration. However, the combination of 2.5 mg oxycodone and active cannabis produced small, yet significant, increases in oxycodone abuse liability (p ≤ 0.05). Cannabis enhances the analgesic effects of sub-threshold oxycodone, suggesting synergy, without increases in cannabis's abuse liability. These findings support future research into the therapeutic use of opioid-cannabinoid combinations for pain.
大麻素与阿片类药物联合使用会产生协同的镇痛作用,降低实验室动物中最低有效镇痛阿片类药物剂量(即阿片类药物节省效应)。尽管疼痛患者报告说,当大麻与阿片类药物一起使用时,他们会有更大的镇痛效果,但没有安慰剂对照研究评估过在人类中阿片类药物与大麻联合使用的直接效果,以及这种联合对滥用倾向的影响。这项双盲、安慰剂对照、个体内研究使用经过验证的疼痛实验模型,确定大麻是否会增强低剂量羟考酮的镇痛效果,以及它对滥用倾向的影响。健康的大麻吸烟者(N=18)接受了口服羟考酮(0、2.5 和 5.0mg)和吸食大麻(0.0、5.6%Δ四氢大麻酚[THC]),并用冷压测试(CPT)评估镇痛效果。参与者将手浸入冷水(4°C)中;记录报告疼痛(痛阈)和将手从水中抽出(痛耐受)的时间。测量了与滥用相关的效果,并确定了羟考酮对大麻自我给药的影响。单独使用 5.0mg 羟考酮可增加痛阈和痛耐受(p≤0.05)。虽然单独使用活性大麻和 2.5mg 羟考酮不能引起镇痛作用,但联合使用时它们会增加痛阈和痛耐受(p≤0.05)。羟考酮没有增加与大麻滥用相关的主观评价,也没有增加大麻自我给药。然而,2.5mg 羟考酮和活性大麻的组合会导致羟考酮滥用倾向的小但显著增加(p≤0.05)。大麻增强了阈下羟考酮的镇痛效果,表明存在协同作用,而大麻的滥用倾向没有增加。这些发现支持进一步研究阿片类药物-大麻联合治疗疼痛的治疗用途。