Single dose cortisol shows promise in treating heroin addiction

The administration of a single dose of cortisol prior to a low dose administration of heroin shows promise in reducing heroin cravings, based on the results of recent research published in Translational Psychiatry.

Given the link between increased stress and increased craving and relapse, the research team, led by Dr. Marc Walter, were interested in examining how cortisol may mediate the effect of stress. What are the mechanisms here? In treating anxiety disorders, it has been demonstrated that the administration of glucocorticoids (such as cortisol) can temporarily reduce the retrieval of types of memory, including aversive memories. Given mounting evidence of partial shared neural circuitry and molecular mechanisms circuitry between memory and addiction, there is promise that aversive addiction-related memory also can be reduced, leading to a reduction in cravings.

In addition to the primary measure of single dose cortisol administration, researchers also assessed the secondary measures of anger, anxiety, and withdrawal symptoms.

Participants in the study attended a treatment center located in Basel, Switzerland. Study participants included 7 women and 22 men with a mean age of 42.4 years. Average duration of heroin use was 23.3 years and an average daily intake of 395.8 mg of heroin. Additionally, participants met the following criteria: age 18 years or older; met criteria for opioid dependence based on ICD-10 factors; history of IV heroin use with no heroin substitute for 3 months; no other illicit drug use during the study; blood alcohol level below 30 ml on each study day.

Participants were excluded from the study if they met the criteria for an additional Axis I disorder (aside from opioid dependence); had recent systemic or topical glucocorticoid therapy or a sensitivity to glucosteroids; had a current medical condition or were pregnant or lactating; had an inability to understand informed consent. Vouchers for use at local grocery stores (valued at 80 Swiss francs) were provided as compensation for participants.

On two study days, between 1 week and 3 weeks apart, the five variables (general craving, heroin craving, anxiety, anger and withdrawal symptoms) were measured in four specified intervals (e.g., baseline, 60 minutes, etc.) after the administration of cortisol.  Assessments included self-report measures, saliva samples and examination of vital signs; a picture-rating task (a picture stimuli designed to elicit cravings) was administered 75 minutes after cortisol administration.

In participants receiving low dose of heroin daily, craving was reduced based on the effects of single dose cortisol administration. No effects were noted among participants receiving medium dose (330-451 mg) or high dose (478-964 mg) daily heroin; there were no differences in heroin dose groups based on age, gender distribution or duration of dependency. Additionally, anxiety, anger, and withdrawal symptoms, secondary measures examined in the study, showed no significant change after cortisol administration.

A limitation of the study was lack of data related to tobacco intake, given nicotine is a modulator of the hypothalamic–pituitary–adrenocortical axis, playing a role in cortisol secretion. As a result, differences in daily cigarette smoking or abstinence prior to testing may have been a factor in cortisol effects on craving. Given the findings, however, the authors conclude there is room for further research to explore the effects of sex steroid hormones and the therapeutic potential of glucocorticoids in addiction. “In particular, it will be of considerable clinical interest to investigate the effects of repeated administration of glucocorticoids and whether glucocorticoids might enhance exposure-based therapy, as it has been shown in phobia. Moreover, it will be of interest to investigate whether cortisol might be suited to prevent relapse in abstinent patients.”