Cortisol a Treatment for Heroin Addiction?

Megan Brooks

July 29, 2015

Administering the stress hormone cortisol to heroin addicts may reduce craving for the drug, a small study suggests.

"Cortisol could be useful in treating addiction. At this point, however, the present study is a proof of concept that cortisol has an influence on craving. A potential clinical relevance has to be tested in further studies," co–lead investigator Dominique de Quervain, MD, director of the Division of Cognitive Neuroscience, at the University of Basel, in Switzerland, told Medscape Medical News.

The study was published online July 28 in Translational Psychiatry.

The investigators tested the effects of cortisol on heroin cravings in a double-blind, placebo-controlled crossover study involving 29 heroin-dependent adults in a stable heroin-assisted treatment program. The patients were given a 20-mg oral dose of cortisol or placebo 105 minutes before receiving a dose of heroin.

Cortisol administration cut heroin cravings by an average of 25% when compared with placebo, as determined on the basis of patient-reported visual analogue scales for craving, the researchers report.

However, this decrease was seen only in patients who were dependent on a relatively low dose of heroin (up to 305 mg/day) and not in patients dependent on higher doses. "It could be that higher doses of cortisol might have been needed, but we don't know," said Dr de Quervain.

Anxiety, anger, and withdrawal symptoms were not significantly affected by cortisol administration.

"We plan studies to examine whether cortisol can help patients reduce their heroin dosage or remain abstinent from heroin for longer," first author and co–lead investigator Marc Walter, PhD, chief physician at the Psychiatric University Clinics (UPK) Basel, told Medscape Medical News. The researchers will also see whether the inhibitory effect of cortisol on addictive cravings might also ease addiction to nicotine, alcohol, or gambling.

Stress has been shown to increase craving and the risk for relapse to opioid dependence. It is possible cortisol reduces craving by interfering with addiction memory, the researchers note.

Therapeutic Target?

"This study is interesting in two different ways, as it sheds new light on the hormone's ability to influence reward behaviors in humans and reveals the possible clinical potential of cortisol administration in addiction," Estrella Montoya, PhD, from the Department of Experimental Psychology, Utrecht University, the Netherlands, told Medscape Medical News.

Dr Montoya was not involved in the Swiss study but said the results are in line with her research in healthy persons, which showed that cortisol administration decreases the reactivity of the reward system and decreases reward drive (Montoya et al. Psychoneuroendocrinology. 2014;47:31-42).

"In my view, this is a promising avenue for research, as the new findings by Walter et al and our findings suggest that administration of cortisol might be a therapeutic target in addiction diseases," Dr Montoya said. "However, much more studies are needed before cortisol administration can become available as a pharmacological treatment in addiction," she noted.

The authors and Dr Montoya report no relevant financial relationships.

Transl Psychiatry. Published online July 28, 2015. Full text

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