oxytocin and Drug-Overdose

Nearly 27 million people have an opioid use disorder (OUD) according to the 2016 Global Burden of Disease study, most of which occur in the US where opioids are a common class of medication used to treat acute and chronic pain. In 2016 alone, more than 60 million patients had at least one prescription for opioids filled or refilled. Over the past decade, prescription rates have risen astronomically and have created an epidemic in the US dubbed the "opioid crisis." In this regard, there has been an increase in overdoses and OUD diagnoses. Several studies have found dysregulation of balance between several neurotransmitters involved in the neural circuitry that subserves several behavioral domains, such as reward recognition, motivation, learning, and memory, affect, stress, and executive function, that contribute to the manifestation of craving. On the horizon is a new treatment approach consisting of the neuropeptide oxytocin, which may be involved in the overlapping mechanisms of stable attachment formation and coping with stress. Through this mechanism, it can shift processing from novelty and reward-seeking to an appreciation of familiarity and thus reduce stress and increase resilience in the face of addiction. It has been hypothesized that there is a connection between the glutaminergic and oxytocinergic systems, making oxytocin a possible therapeutic agent in reducing drug-induced actions seen in OUD patients. This manuscript will review the potential and feasible use of oxytocin in treating OUD.

Topics: Analgesics, Opioid; Chronic Pain; Drug Overdose; Humans; Opioid-Related Disorders; Oxytocin

Pregnancy in a patient in a persistent vegetative state presents challenging therapeutic questions about the level of supportive management required, the assessment of fetal well-being, the timing and mode of delivery and the anaesthetic management of labour and delivery. We report the case of a 29-yr-old woman who had a favourable fetal outcome despite suffering hypoxic brain damage after a suicide attempt by a drug overdose. She was managed until the onset of labour on an intensive care unit and had a spontaneous vaginal delivery assisted by epidural anaesthesia.

Topics: Adult; Amnion; Anesthesia, Epidural; Anesthesia, Obstetrical; Anesthetics, Local; Bupivacaine; Decision Making; Drug Overdose; Female; Humans; Hypoxia, Brain; Labor, Induced; Oxytocin; Persistent Vegetative State; Pregnancy; Pregnancy Complications; Suicide, Attempted

A primigravid woman was seen for the first time in a disoriented and combative state, with regular, painful uterine contractions. Evaluation revealed a negative illicit drug screen, no evidence of preeclampsia, and a nonfocal neurologic examination. Further workup revealed urinary diphenhydramine levels suggesting drug overdose. This case serves as a reminder of the oxytocin-like effects of diphenhydramine.

Topics: Adult; Diphenhydramine; Drug Overdose; Female; Humans; Oxytocin; Pregnancy; Uterine Contraction

Topics: Adult; Drug Overdose; Equipment Failure; Female; Humans; Infant, Newborn; Infusion Pumps; Magnesium Sulfate; Oxytocin; Poisoning; Pregnancy

Topics: Aged; Drug Overdose; Female; Humans; Labor, Obstetric; Obstetric Labor Complications; Oxytocin; Pregnancy