The Cholinergic System as a Treatment Target for Opioid Use Disorder

• Published in: CNS drugs Vol. 32; no. 11; pp. 981 - 996
• Main Authors: Jensen, Kevin P., DeVito, Elise E., Yip, Sarah, Carroll, Kathleen M., Sofuoglu, Mehmet
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01-11-2018; Springer Nature B.V
• Subjects: Accidental deaths; Acetylcholine; Acetylcholine - pharmacology; Acetylcholine - therapeutic use; Alcohol; Alzheimer's disease; Analgesics, Opioid - pharmacology; Analgesics, Opioid - therapeutic use; Animals; Buprenorphine; Central nervous system; Cholinergic Agents - pharmacology; Cholinergic Agents - therapeutic use; Cholinergic transmission; Cholinesterase inhibitors; Clinical trials; Cocaine; Cognition; Cognition & reasoning; Comorbidity; Drug addiction; Drug overdose; Endorphins; Humans; Infections; Kinases; Leading Article; Medicine; Medicine & Public Health; Mental depression; Methadone; Naltrexone; Narcotics; Nausea; Nervous system; Neurodegenerative diseases; Neurology; Neurosciences; Non-Neuronal Cholinergic System - drug effects; Opioid-Related Disorders - drug therapy; Opioids; Overdose; Pain; Peptides; Pharmacotherapy; Post traumatic stress disorder; Psychiatry; Psychopharmacology; Reinforcement; Scopolamine; Smoking cessation; Substance abuse treatment; Substance use disorder; Tobacco; United States > US
• ISSN: 1172-7047; 1179-1934
• DOI: 10.1007/s40263-018-0572-y

Opioid overdoses recently became the leading cause of accidental death in the US, marking an increase in the severity of the opioid use disorder (OUD) epidemic that is impacting global health. Current treatment protocols for OUD are limited to opioid medications, including methadone, buprenorphine, and naltrexone. While these medications are effective in many cases, new treatments are required to more effectively address the rising societal and interpersonal costs associated with OUD. In this article, we review the opioid and cholinergic systems, and examine the potential of acetylcholine (ACh) as a treatment target for OUD. The cholinergic system includes enzymes that synthesize and degrade ACh and receptors that mediate the effects of ACh. ACh is involved in many central nervous system functions that are critical to the development and maintenance of OUD, such as reward and cognition. Medications that target the cholinergic system have been approved for the treatment of Alzheimer’s disease, tobacco use disorder, and nausea. Clinical and preclinical studies suggest that medications such as cholinesterase inhibitors and scopolamine, which target components of the cholinergic system, show promise for the treatment of OUD and further investigations are warranted.