Utility of fentanyl vaccines: unique challenges posed by preventing opioid overdose and treating opioid use disorder

摘要

O’Brien [5] demonstrated conditioned opioid withdrawal in humans in a laboratory experiment. This excerpt from the study provides a naturalistic description of the way in which re-exposure to conditioned stimuli, independent of the pharmacological effects of the drug, may powerfully motivate drug seeking and taking long into drug abstinence. Opioid use disorder is thought to involve the dysregulation of brain reward and stress systems that contribute to negative emotional states. These motivational withdrawal symptoms can be precipitated by internal and external conditioned withdrawal cues, persist well beyond physical (somatic) withdrawal symptoms, and powerfully motivate drug seeking and taking in an effort to alleviate these negative emotional states. A vaccine that targets fentanyl to block access of the drug to the brain could play a critical role in preventing overdoses that are produced by heroin that is laced with the potent opioid fentanyl. However, this approach would be expected to have little effect on key features of opioid use disorder that motivate drug-taking behavior