Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA 98195, United States of America.
Department of Pharmaceutics, School of Pharmacy, University of Washington, Seattle, WA 98195, United States of America.
Pharmacol Biochem Behav. 2021 Dec;211:173295. doi: 10.1016/j.pbb.2021.173295. Epub 2021 Nov 4.
Regular alcohol consumption is on the rise among older adults and has the potential of altering the subjective experience of pain and response to pain medications. This study examined the cognitive, analgesic and side effect response to oxycodone in middle age and older adults with elevated levels of customary alcohol consumption in a human laboratory setting.
After refraining from alcohol for one day, eligible participants underwent baseline assessment cognition and side effects by means of questionnaires that were repeated at three time points (90 min, 5 and 8 h) following administration of a 10 mg oral dose of oxycodone. Response to pain stimulus (Cold Pressor Test (CPT)), pupil size, and plasma oxycodone were also measured.
One hundred twenty-eight adults (age 35-85) completed the study day. Compared to those with lower customary alcohol consumption, participants with elevated alcohol consumption showed attenuated opioid-induced pupil constriction and cognitive decline on objective measures of working memory, sustained attention, inhibitory control, coordination on a simulated driving task, and subjective dysphoric effects with enhanced subjective euphoric effects. Oxycodone pharmacokinetics, pain tolerance to CPT, and Berg balance were impacted comparably between alcohol consumption groups. Women endorsed greater negative drug effects, whereas men endorsed positive drug effects.
Independent of subject's age, elevated customary alcohol consumption attenuates opioid central effects (i.e., pupil miosis, impaired cognition) and gender influences subjective drug effects. Clinicians should consider alcohol consumption and gender when prescribing opioid medications.
在老年人中，常规饮酒量呈上升趋势，这有可能改变他们对疼痛的主观体验和对疼痛药物的反应。本研究在人体实验室环境中，检查了习惯性饮酒水平较高的中年和老年人中，阿片类药物奥施康定的认知、镇痛和副作用反应。
在一天不饮酒后，合格的参与者接受了基线认知评估和副作用评估，方法是通过问卷进行，在给予 10 毫克口服剂量的奥施康定后，分别在 90 分钟、5 小时和 8 小时三个时间点重复进行。还测量了疼痛刺激（冷加压试验 (CPT)）、瞳孔大小和血浆奥施康定的反应。
128 名成年人（年龄 35-85 岁）完成了研究日的实验。与习惯性饮酒量较低的参与者相比，习惯性饮酒量较高的参与者表现出阿片类药物诱导的瞳孔收缩和认知能力下降减弱，这在工作记忆、持续注意力、抑制控制、模拟驾驶任务中的协调以及主观快感增强和主观不适增加等客观测量中得到了体现。奥施康定药代动力学、CPT 疼痛耐受度和伯格平衡在饮酒量组之间受到类似的影响。女性报告的药物不良反应更大，而男性报告的药物积极影响更大。
独立于受试者的年龄，习惯性饮酒量增加会减弱阿片类药物的中枢作用（即瞳孔缩小、认知受损），且性别会影响主观药物作用。临床医生在开具阿片类药物处方时应考虑到酒精摄入量和性别。
