Opioids, including oxycodone, are very effective medications for pain, but they have an unfortunate potential for addiction that could lead to misuse and dependence. However, researchers found a relationship between the FDA-approved suvorexant and opioid relapse, determining that it decreased the amount of oxycodone self-administered by opioid-dependent rats.
Now, following that same research, scientists from a Scripps Research study determined that an experimental medication for insomnia, known as DORA-12, could help prevent drug relapse in patients with oxycodone addiction by targeting this common but often overlooked side effect.
Let’s explore how DORA-12 could make opioid addiction treatment safer for everyone if it proves to be safe and effective.
The Cycle of Opioid Addiction and Relapse
The cycle of opioid abuse, addiction, recovery, and relapse has a firm grip on many people’s lives. Here’s how most people’s addiction develops after starting to take opioids:
- Tolerance: As individuals use opioids over time, their brains adjust to the dose, needing larger amounts to achieve the same pain-relieving effects.
- Dependence: Continued opioid use leads to physical dependence, where the body relies on the drug to function normally. Withdrawal symptoms like shaking and headaches occur when attempting to stop or reduce usage.
- Abuse: This stage involves the misuse of opioids, such as taking higher doses than prescribed or obtaining them illegally. By now, most people can’t control their cravings for opioids and might even say their bodies need them to function correctly.
- Addiction or opioid use disorder: At this stage, people compulsively seek opioids despite being aware of the negative consequences.
At some point after addiction sets in, people may seek treatment through an inpatient or outpatient facility, but many relapse. In some cases, as much as 90% of people who go through residential opioid treatment relapse at some point, many within a week of leaving the facility.
The Role of Insomnia in Opioid Relapse
People with insomnia experience a higher risk of relapsing back into opioid use. Insomnia can be a condition the individual experienced before addiction, or it can be a result of addiction, a condition known as medication-induced sleep disorder.
Insomnia worsens the risk of relapse by:
- Making people more vulnerable to stress.
- Reducing cognitive functions which can lead to poor decision-making.
- Exacerbating existing mental health conditions can, in turn, increase the risk of relapse as a means to numb negative emotions.
- In cases of chronic sleep deprivation, increasing pain sensitivity (hyperalgesia) leads some to consume opioids to reduce it.
Despite not being as talked about as other factors, sleep disturbances play a significant role in the risk of relapse.
Study Highlights: DORA-12’s Potential in Preventing Opioid Relapse
In August 2023, scientists found that the insomnia drug DORA-12 yields interesting results on rats who experience oxycodone withdrawal.
The Study
The study involved administering the experimental insomnia drug DORA-12 to rats that were undergoing withdrawal from oxycodone to determine if the drug could reduce the desire to seek opioids. The researchers monitored the behavior of the rats to determine the effects of DORA-12 on opioid cravings.
The Results
Scientists noticed that rats treated with DORA-12 during withdrawal from oxycodone showed a reduction in drug-seeking behavior. The study doesn’t provide details for how DORA-12 could reduce oxycodone cravings, but the results suggest that the drug potentially mitigates the cravings for opioids.
The researchers also noted differences in responses between male and female rats, which suggests varying impacts based on sex. The drug was less effective in female rats, and males showed pronounced changes in neuron numbers. It could be possible that female animals are more sensitive to oxycodone’s effects and require different DORA-12 doses.
DORA-12 is similar to the FDA-approved drug Belsomra (suvorexant), and research shows that suvorexant decreased the amount of oxycodone self-administered by opioid-dependent rats during binge sessions.
Rats given DORA-12 during their withdrawal period show patterns of behavior and psychological activities seen in animals without opioid dependence, not showing any drug-seeking behaviors even when exposed to cues they had learned to associate with oxycodone.
Implications for Treatment and Recovery
If the effects researchers observed translate to humans and DORA-12 is approved for safe use, the drug may have the potential to address insomnia as a relapse risk factor. Specialists could integrate DORA-12 into treatment plans for individuals struggling with opioid addiction, particularly those facing significant challenges with insomnia.
DORA-12 could:
- Minimize insomnia in patients going through withdrawal symptoms. Patients who rest better could experience less severe withdrawals, reducing their chances of a relapse.
- Reduce drug-seeking behaviors. The study found that rats treated with DORA-12 during opioid withdrawal showed reduced drug-seeking behavior, even after the treatment ceased.
Both factors have the potential to make withdrawal syndrome much more manageable for people in treatment for opioid addiction. However, it would be essential to consider how the drug affected males and females differently, being less in female rats. All this is currently theoretical, as it could be years before DORA-12 even sees human use in clinical trials.
Still, the research highlights the connection between sleep and addiction. Addressing insomnia during addiction treatment may have far-reaching implications for the prevention and treatment of various substance use disorders.
By recognizing the importance of sleep in addiction recovery and integrating innovative insomnia treatments into recovery programs, healthcare providers could offer more comprehensive and effective care to individuals struggling with addiction.
DORA-12 and the Future of Opioid Addiction Treatment
The research on DORA-12 is a promising breakthrough in treating insomnia as a risk factor for opioid addiction relapse. By targeting insomnia, DORA-12 has shown potential in reducing drug-seeking behavior and enhancing recovery outcomes in opioid-dependent rats.
While it could be years before we even start testing whether this drug could work in humans, innovative research like this shows just how complex addiction is and how many factors play a role in our recovery.
Even though we need more research to confirm its efficacy and safety in humans, it’s encouraging to know that we have hard-working researchers exploring every possibility to understand opioid addiction and how to treat it.
