This project explores pharmacodynamic approaches to developing new treatments for drug dependence and reduction of HIV transmission risk behaviors, with a current focus on cocaine, marijuana, and nicotine dependence. Many subjects are at high risk for contracting and spreading HIV infection. HIV transmission risk behaviors are assessed and HIV testing and risk reduction counseling are offered to all subjects. The pharmacokinetic approach being studied is blunting the rate of onset of drug effect by enhancement of drug metabolism. Rate of onset of drug effect is considered an important influence on the reinforcing effects of drugs. The influence of rate has treatment implications, in that drugs from the same pharmacologic class but with slower rate of onset may have therapeutic efficacy without themselves inducing addiction. Pharmacodynamic approaches being studied include modulation of brain neurotransmitters and blockade of relevant neurotransmitter receptors. The former approach is being implemented using transcranial magnetic stimulation (TMS), in collaboration with the Maryland Psychiatric Research Center. TMS involves projecting pulsed magnetic fields through the skull into the brain, where they alter neuronal firing and change levels of neurotransmitters. TMS is a safe, non-invasive way of modulating activity in brain circuits that mediate drug craving and reward, thus offering a potential treatment for drug addiction. Pilot studies are being conducted to evaluate the safety and efficacy of either single-pulse or low-frequency repetitive TMS in users of cannabis, cocaine, and nicotine. A pilot study showed that functional magnetic resonance imaging (fMRI) could be successfully used to target TMS pulses to a desired brain region. The second approach is being implemented, in collaboration with the Chemistry &Drug Metabolism Section and the Maryland Psychiatric Research Center, by evaluating the effects in humans of an experimental compound, rimonabant, which acts as an antagonist at the cannabinoid 1 (CB1, marijuana) receptor in the brain. Previous studies found that rimonabant blocked the effects of smoked marijuana, without altering THC plasma pharmacokinetics, suggesting that CB1 receptors play an important role in mediating the effects of marijuana in humans. Recently terminated studies evaluated the interaction of rimonabant with oral THC and its safety and efficacy in patients with schizophrenia.
| Boggs, Douglas L; Kelly, Deanna L; Liu, Fang et al. (2013) Cannabis withdrawal in chronic cannabis users with schizophrenia. J Psychiatr Res 47:240-5 |
| Danovitch, Itai; Gorelick, David A (2012) State of the art treatments for cannabis dependence. Psychiatr Clin North Am 35:309-26 |
| Minkowski, Carolynne P; Epstein, David; Frost, J James et al. (2012) Differential response to IV carfentanil in chronic cocaine users and healthy controls. Addict Biol 17:149-55 |
| Gorelick, David A; Levin, Kenneth H; Copersino, Marc L et al. (2012) Diagnostic criteria for cannabis withdrawal syndrome. Drug Alcohol Depend 123:141-7 |
| Gorelick, David A (2012) Pharmacokinetic strategies for treatment of drug overdose and addiction. Future Med Chem 4:227-43 |
| Martins, Silvia S; Gorelick, David A (2011) Conditional substance abuse and dependence by diagnosis of mood or anxiety disorder or schizophrenia in the U.S. population. Drug Alcohol Depend 119:28-36 |
| Harrell, P T; Montoya, I D; Preston, K L et al. (2011) Cigarette smoking and short-term addiction treatment outcome. Drug Alcohol Depend 115:161-6 |
| Weinstein, A M; Gorelick, David A (2011) Pharmacological treatment of cannabis dependence. Curr Pharm Des 17:1351-8 |
| Kelly, Deanna L; Gorelick, David A; Conley, Robert R et al. (2011) Effects of the cannabinoid-1 receptor antagonist rimonabant on psychiatric symptoms in overweight people with schizophrenia: a randomized, double-blind, pilot study. J Clin Psychopharmacol 31:86-91 |
| Levin, Kenneth H; Copersino, Marc L; Heishman, Stephen J et al. (2010) Cannabis withdrawal symptoms in non-treatment-seeking adult cannabis smokers. Drug Alcohol Depend 111:120-7 |
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