College of Nursing, Medical University of South Carolina, United States; Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, United States.
Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, United States.
Addict Behav. 2019 May;92:148-154. doi: 10.1016/j.addbeh.2018.12.022. Epub 2019 Jan 5.
Opioid dependence is a significant public health problem in the United States and the number of opioid overdose deaths among women has increased dramatically in comparison to men in the last few years. In this context, understanding the biological mechanisms underlying gender differences in vulnerability to opioid dependence is essential.
The current pilot study examined gender differences in subjective stress, heart rate (HR), and cortisol/dephydroepiandrosterone (DHEA) response to a laboratory stressor (Trier Social Stress Test; TSST) or a no-stress condition, and drug cue paradigm among men (n = 21) and women (n = 18) with opioid dependence.
Significant group (TSST vs. no stress) differences emerged in self-reported stress [F(1,35) = 23.8, p < .001], HR [F(1,31) = 12.3; p = .001] and cortisol (F = 5.0; p = .032) response, such that the TSST group was more reactive than the no-stress group. Women reported greater subjective stress [F(1,35) = 6.5, p <= .015] in response to the TSST compared to men. However, men evidenced marginally greater cortisol and DHEA responses to the TSST compared to women [F(1,34) = 2.7; p = .113 and F(1,31) = 3.4; p = .073, respectively].
Although women with opioid dependence reported greater subjective stress when exposed to a laboratory stress paradigm as compared to men, the neuroendocrine response was more robust in men. This pattern was similar to gender findings in men and women with cocaine and tobacco use disorders. The blunted cortisol combined with an increased subjective response among women may be a sign of HPA axis dysregulation which could increase vulnerability to relapse in women.
阿片类药物依赖是美国一个严重的公共卫生问题，在过去几年中，女性阿片类药物过量死亡人数与男性相比急剧增加。在这种情况下，了解女性易患阿片类药物依赖的生物学机制至关重要。
本初步研究考察了男性（n=21）和女性（n=18）阿片类药物依赖者在实验室应激源（特里尔社会应激测试；TSST）或无应激条件下以及药物线索范式下，主观应激、心率（HR）和皮质醇/脱氢表雄酮（DHEA）反应的性别差异。
在自我报告的应激[F（1,35）=23.8，p<0.001]、HR[F（1,31）=12.3；p=0.001]和皮质醇（F=5.0；p=0.032）反应方面，出现了显著的组（TSST 与无应激）差异，TSST 组比无应激组反应更强烈。与男性相比，女性在 TSST 应激下报告的主观应激更大[F（1,35）=6.5，p<=0.015]。然而，与女性相比，男性对 TSST 的皮质醇和 DHEA 反应略高[F（1,34）=2.7；p=0.113 和 F（1,31）=3.4；p=0.073，分别]。
尽管与男性相比，患有阿片类药物依赖的女性在暴露于实验室应激范式时报告的主观应激更大，但男性的神经内分泌反应更强烈。这种模式与男性和女性可卡因和烟草使用障碍患者的性别发现相似。女性皮质醇水平降低加上主观反应增加可能是 HPA 轴失调的迹象，这可能会增加女性复发的脆弱性。
