Elevated customary alcohol consumption attenuates opioid effects

• Published in: Pharmacology, biochemistry and behavior Vol. 211; p. 173295
• Main Authors: Cherrier, Monique M., Shen, Danny D., Shireman, Laura, Saxon, Andrew J., Simpson, Tracy, Men, Alex, Kooner, Preetma, Terman, Gregory W.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.2021
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Aging; Alcohol; Alcohol Drinking; Analgesics, Opioid - administration & dosage; Attention - drug effects; Attenuation; Automobile Driving; Cognition; Cognition - drug effects; Elderly; Ethanol - administration & dosage; Female; Humans; Male; Memory, Short-Term - drug effects; Middle Aged; Miosis; Miosis - etiology; Opioid; Oxycodone; Oxycodone - administration & dosage; Oxycodone - adverse effects; Pain; Pain - drug therapy; Sex Factors; Surveys and Questionnaires; Pain; Oxycodone; Opioid; Aging; Alcohol; Attenuation; Cognition; Miosis; Elderly
• DOI: 10.1016/j.pbb.2021.173295
• ISSN: 0091-3057; 1873-5177

Regular alcohol consumption is on the rise among older adults and has the potential of altering the subjective experience of pain and response to pain medications. This study examined the cognitive, analgesic and side effect response to oxycodone in middle age and older adults with elevated levels of customary alcohol consumption in a human laboratory setting. After refraining from alcohol for one day, eligible participants underwent baseline assessment cognition and side effects by means of questionnaires that were repeated at three time points (90 min, 5 and 8 h) following administration of a 10 mg oral dose of oxycodone. Response to pain stimulus (Cold Pressor Test (CPT)), pupil size, and plasma oxycodone were also measured. One hundred twenty-eight adults (age 35–85) completed the study day. Compared to those with lower customary alcohol consumption, participants with elevated alcohol consumption showed attenuated opioid-induced pupil constriction and cognitive decline on objective measures of working memory, sustained attention, inhibitory control, coordination on a simulated driving task, and subjective dysphoric effects with enhanced subjective euphoric effects. Oxycodone pharmacokinetics, pain tolerance to CPT, and Berg balance were impacted comparably between alcohol consumption groups. Women endorsed greater negative drug effects, whereas men endorsed positive drug effects. Independent of subject's age, elevated customary alcohol consumption attenuates opioid central effects (i.e., pupil miosis, impaired cognition) and gender influences subjective drug effects. Clinicians should consider alcohol consumption and gender when prescribing opioid medications. •Oxycodone impact on the central nervous system (CNS) as indicated by pupil constriction (miosis) is reduced or attenuated in middle age persons who consume heavier amounts of alcohol (average 3.3 drinks per day/ 25 drinks per week).•Oxycodone typically impairs cognition around 90 minutes following consumption of a 10mg dose, however, for middle age persons with customary alcohol consumption habits in the heavier range (average 3.3 drinks per day/ 25 drinks per week) there is reduced or minimal impairment of attention, working memory, declarative memory, inhibitory control, and performance on a simulated driving task.•Women in comparison to men, particularly women with elevated levels of customary alcohol consumption, did not demonstrate the typical increase in analgesia from oxycodone (10mg) in response to an experimental pain stimulus.•Male gender, prior experience of drug use and heavier customary alcohol consumption were all associated with stronger endorsement of positive or good drug effects from oxycodone.