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Blum K, Giordano J, Baron D, McLaughlin T, Badgaiyan RD. Proposing FDA consideration for the treatment and prophylaxis of opioid and psychostimulant abuse to incorporate the induction of DNA guided dopamine homeostasis: Anti-reward deficiency restoration solution (ARDS). J Syst Integr Neurosci 2020; 8:10.15761/JSIN.1000253. [PMID: 36407844 PMCID: PMC9670280 DOI: 10.15761/jsin.1000253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND In face of an American opioid/psychostimulant crisis with overdose fatalities, due, in part, to the COVOD 19 pandemic, we are proposing a paradigm shift in response. Currently, The FDA has approved pharmaceuticals for the treatment of opioids, alcohol, and nicotine but not for psychostimulants or even cannabis. PROPOSITION To respond to the deadly overdose issue globally, we are proposing that the FDA embrace, for the treatment and prophylaxis of opioid and psychostimulant abuse, induction of DNA-guided, dopamine homeostasis. We refer to this novel therapeutic target as the Anti-Reward Deficiency Restoration Solution (ARDS). EXPERT OPINION This futuristic proposal regarding the FDA will provide important information that may ultimately lead to significant improvement in the recovery of individuals with opioid/psychostimulant and polydrug abuse issues, especially, those with genetically-induced dopamine deficiency. CONCLUSION With large populations supporting these initial results, and possibly even additional candidate genes and single nucleotide polymorphisms, the neuroscience and neurological community may eventually have the clinical ability to classify addiction severity, according to genotype and possession of risk alleles. A promising goal is the identification of high risk vulnerability, along with the provision of a safe, non-addicting ARDS natural nutrigenomic, involving a therapeutic model that potentially up-regulates instead of down-regulates dopaminergic receptors, preferably, the D2 subtype, is one laudable goal.
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Affiliation(s)
- Kenneth Blum
- Western University Health Sciences, Graduate College, Pomona CA, USA
- The Kenneth Blum Behavioral & Neurogenetic Institute (Division of Ivitalize) Austin, TX, USA
| | - John Giordano
- The Kenneth Blum Behavioral & Neurogenetic Institute (Division of Ivitalize) Austin, TX, USA
| | - David Baron
- Western University Health Sciences, Graduate College, Pomona CA, USA
| | - Thomas McLaughlin
- The Kenneth Blum Behavioral & Neurogenetic Institute (Division of Ivitalize) Austin, TX, USA
| | - Rajendra D Badgaiyan
- Department of Psychiatry, South Texas Veteran Health Care System, Audie L. Murphy Memorial VA Hospital, San Antonio, TX, Long School of Medicine, University of Texas Medical Center, San Antonio, TX, USA
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Blum K, Lott L, Baron D, Smith DE, Badgaiyan RD, Gold MS. Improving naltrexone compliance and outcomes with putative pro- dopamine regulator KB220, compared to treatment as usual. ACTA ACUST UNITED AC 2020; 7. [PMID: 32934823 PMCID: PMC7489288 DOI: 10.15761/jsin.1000229] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A recent analysis from Stanford University suggested that without any changes in currently available treatment, prevention, and public health approaches, we should expect to have 510,000 deaths from prescription opioids and street heroin from 2016 to 2025 in the US. In a recent review, Mayo Clinic Proceedings (October 2019), Gold and colleagues at Mayo Clinic reviewed the available medications used in opioid use disorders and concluded that in private and community practice adherence is more important as a limiting factor to retention, relapse, and repeat overdose. It is agreed that the primary utilization of known opioid agonists like methadone, buprenorphine and naloxone combinations, while useful as a way of reducing societal harm, is limited by 50% of more discontinuing treatment within 6 months, their diversion, and addiction liability. Opioid agonists may have other unintended consequences, like continuing the down regulation of dopamine systems. While naltrexone would be expected to have opposite effects, adherence is also low even after detoxification and long acting naltrexone injections. Recent studies have shown Naltrexone is beneficial by attenuation of craving via “psychological extinction” and reducing relapse. Buprenorphine is the MAT of choice currently but injectable Naltrexone plus an agent to improve dopaminergic function and tone may renew interest amongst addiction physicians and patients. Understanding this dilemma there is increasing movement to opt for the non-addicting narcotic antagonist Naltrexone. Even with extended injectable option there is still poor compliance. As such, we describe an open label investigation in humans showing improvement of naltrexone compliance and outcomes with dopamine augmentation with the pro- dopamine regulator KB220 (262 days) compared to naltrexone alone (37days). This well studied complex consists of amino-acid neurotransmitter precursors and enkephalinase inhibitor therapy compared to treatment as usual. Consideration of this novel paradigm shift may assist in not only addressing the current opioid epidemic but the broader question of reward deficiency in general.
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Affiliation(s)
- Kenneth Blum
- Western University Health Sciences, Graduate College, Pomona, CA, USA
| | - Lisa Lott
- Division of Behavioral Precision Management, Geneus Health, LLC, San Antonio, TX, USA
| | - David Baron
- Western University Health Sciences, Graduate College, Pomona, CA, USA
| | - David E Smith
- Department of Pharmacology, University of California San Francisco School of Medicine, San Francisco, CA, USA
| | - Rajendra D Badgaiyan
- Department of Psychiatry, Icahn School of Medicine Mt Sinai, New York, NY, USA and Department of Psychiatry, South Texas Veteran Health Care System, Audie L. Murphy Memorial VA Hospital, San Antonio, TX, Long School of Medicine, University of Texas Medical Center, San Antonio, TX, USA
| | - Mark S Gold
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Mo, USA
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Blum K, Gold M, Modestino EJ, Baron D, Boyett B, Siwicki D, Lott L, Podesta A, Roy AK, Hauser M, Downs BW, Badgaiyan RD. Would induction of dopamine homeostasis via coupling genetic addiction risk score (GARS®) and pro-dopamine regulation benefit benzodiazepine use disorder (BUD)? ACTA ACUST UNITED AC 2018; 4. [PMID: 31750006 PMCID: PMC6865059 DOI: 10.15761/jsin.1000196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Prescriptions for Benzodiazepines (BZDs) have risen continually. According to national statistics, the combination of BZDs with opioids has increased since 1999. BZDs (sometimes called “benzos”) work to calm or sedate a person by raising the level of the inhibitory neurotransmitter GABA in the brain. In terms of neurochemistry, BZDs act at the GABAA receptors to inhibit excitatory neurons, reducing VTA glutaminergic drive to reduce dopamine release at the Nucleus accumbens. Benzodiazepine Use Disorder (BUD) is very difficult to treat, partly because BZDs are used to reduce anxiety which paradoxically induces hypodopaminergia. Considering this, we are proposing a paradigm shift. Instead of simply targeting chloride channel direct GABAA receptors for replacement or substitution therapy, we propose the induction of dopamine homeostasis. Our rationale is supported by the well-established notion that the root cause of drug and non-drug addictions (i.e. Reward Deficiency Syndrome [RDS]), at least in adults, involve dopaminergic dysfunction and heightened stress. This proposition involves coupling the Genetic Addiction Risk Score (GARS) with a subsequent polymorphic matched genetic customized Pro-Dopamine Regulator known as KB220ZPBM (Precision Behavioral Management). Induction of dopamine homeostasis will be clinically beneficial in attempts to combat BUD for at least three reasons: 1) During detoxification of alcoholism, the potential induction of dopamine regulation reduces the need for BZDs; 2) A major reason for BZD abuse is because people want to achieve stress reduction and subsequently, the potential induction of dopamine regulation acts as an anti-stress factor; and 3) BUD and OUD are known to reduce resting state functional connectivity, and as such, potential induction of dopamine regulation enhances resting state functional connectivity. Future randomized placebo-controlled studies will investigate this forward thinking proposed novel modality.
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Affiliation(s)
- K Blum
- Western University Health Sciences, Graduate School of Biomedical Sciences, Pomona, CA, USA.,Division of Nutrigenomics, Geneus Health, LLC., San Antonio, TX, USA.,Division of Neuroscience & Addiction Research, Pathway Healthcare, LLc., Birmingham, AL, USA.,Division of Addiction Services, Dominion Diagnostics, LLC. North Kingstown, RI, USA.,Division of Nutrigenomic Research, Victory Nutrition International, Lederach, PA, USA
| | - M Gold
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Mo, USA
| | - E J Modestino
- Department of Psychology, Curry College, Milton, MA, USA
| | - D Baron
- Western University Health Sciences, Graduate School of Biomedical Sciences, Pomona, CA, USA.,Division of Nutrigenomics, Geneus Health, LLC., San Antonio, TX, USA
| | - B Boyett
- Division of Neuroscience & Addiction Research, Pathway Healthcare, LLc., Birmingham, AL, USA
| | - D Siwicki
- Division of Nutrigenomics, Geneus Health, LLC., San Antonio, TX, USA
| | - L Lott
- Division of Nutrigenomics, Geneus Health, LLC., San Antonio, TX, USA
| | - A Podesta
- Department of psychiatry, Tulane University School of Medicine, New Orleans, LA, USA
| | - A K Roy
- Department of psychiatry, Tulane University School of Medicine, New Orleans, LA, USA
| | - M Hauser
- Division of Addiction Services, Dominion Diagnostics, LLC. North Kingstown, RI, USA
| | - B W Downs
- Division of Nutrigenomic Research, Victory Nutrition International, Lederach, PA, USA
| | - R D Badgaiyan
- Department of Psychiatry, Veterans Administration Hospital at San Antonio, San Antonio, TX, USA
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