RESTRICTING REINSTATEMENT OF DRUG USE

Abstract: alpha -2 adrenergic receptor agonists are used as medication for recovering addicts, to prevent or reduce the stress-induced reinstatement of seeking addictive materials, such as heroin, cocaine, ethanol or nicotine. Suitable alpha-2 adrenergic receptor agonists include guanabenz, clonidine, and especially lofexidine.

Description: RESTRICTING REINSTATEMENT OF DRUG USE This invention relates to pharmaceutical treatments for preventing or reducing the reinstatement of addictive drug use. When a mammal has become addicted to an addictive material, the mammal may abstain from further use due to non-availability of the addictive material, due to physical or mental treatment, or simply by willpower. Under most circumstances the abstaining addict will relapse, and reinstate use of the addictive material, due to craving for the substance, or due to social or peer pressure. In humans, experimental evidence shows that psychological stress can provoke craving for cocaine in cocaine addicts. In animal models of stress-induced reinstatement of addictive drug seeking, stress in the form of electric foot-shock has been shown to induce the relapse of rats addicted to heroin, cocaine, nicotine and alcohol. It has previously been proposed that clonidine and lofexidine can be used to alleviate withdrawal symptoms in patients being treated for addiction to opiates. For example the use of some oc-2 adrenergic receptor agonists in treating the short term side effects of drug withdrawal is known from US 4 800 209. Euro. J. Neurosci., Vol. 12, pp 292-302, 2000, provides data indicating that clonidine is also effective in reducing foot-shock-induced reinstatement of heroin-seeking in heroin-addicted rats. On the basis of further foot-shock data, the present invention proposes treatment regimes for opiate (e.g. heroin) and non-opiate (e.g. cocaine, ethanol, nicotine) addiction based on administration of cc-2 adrenergic receptor agonists. For treatment of opiate addicts, narcotic antagonists may be used to treat addicts so as to block the euphoric effects of any opiates subsequently ingested, and this is used to nullify the effect of reinstatement of opiate use. When this regime is coupled with the use of oc-2 adrenergic receptor agonists in accordance with the present invention, to alleviate stress-induced recidivism, an opiate addict is provided with an effective recovery programme. An alternative regime for opiate addicts is a maintenance programme, using an opiate substitute which does not produce a euphoric effect. The use of an opiate substitute means that the addict does not suffer from withdrawal symptoms, but its lack of a euphoric effect results in the treated addict being susceptible to stress- induced craving for illicit opiates, which are taken as well a the substitute. This is solved in accordance with the present invention, by administration of cc-2 adrenergic receptor agonists. Therefore, in a first aspect, the present invention provides methods of preventing or reducing stress-induced reinstatement of addictive material-seeking in a treatment regime which comprise treating a mammal addicted to an opiate either by administering an effective amount of a narcotic antagonist, or by administering an opiate substitute, in which the existing therapy is carried out in combination with administration of an effective amount of an cc-2 adrenergic receptor agonist. The cc-2 adrenergic receptor agonist may be used in combination therapy, where it is administered sequentially, simultaneously or conjointly with a narcotic antagonist or with an opiate substitute. For the treatment of addicts to non-opiates, existing therapies rely principally on abstinence programmes with peer support, and relapse under stress is alleviated in accordance with the present invention, by administration of oc-2 adrenergic receptor agonists. Therefore in a second aspect, the present invention provides a method of preventing or reducing stress-induced reinstatement of addictive material-seeking which comprises treating a mammal addicted to an non-opiate by administering an effective amount of an oc-2 adrenergic receptor agonist. In this aspect of the invention it is expected that the addict will be refraining from use of the addictive material during the treatment and so the addict will be administered solely the oc-2 adrenergic receptor agonist. According to the invention there is also provided the use of an oc-2 adrenergic receptor agonist in the manufacture of a medicament for use in the treatment regimes indicated above. Alternatively, the use of the α-2 adrenergic receptor agonist may be combined with a programme of treatment with an agonist for the addictive substance, or a compound that produces an unpleasant effect, such as nausea, if there is illicit use of the addictive substance. The use of an α-2 adrenergic receptor agonist in accordance with this invention has also been found to be effective against reinstatement of multiple drug abuse, for example in treatment of users of so-called "speedballs", a mixture of heroin and cocaine. In both aspects of this invention, it may still be necessary initially to treat acute withdrawal symptoms with, for example, clonidine or lofexidine, or with a medicament other than an alpha 2 adrenergic receptor agonist, such as the nonapeptide described in US 4 1496 545. Whereas treatment of withdrawal symptoms with oc-2 adrenergic receptor agonists requires administration of these compounds for periods of a few days, treatment to reduce the risk of reinstatement in accordance with the present invention will typically require administration of the compounds for several months. By way of example, the addictive opiate material may be heroin or morphine, and the addictive non-opiate material may be one or more or of cocaine, ethanol or nicotine. Examples of suitable alpha-2 adrenergic receptor agonists include guanabenz, lofexidine and clonidine. Lofexidine is preferred. Narcotic antagonists used to block the euphoric effects of opiates, and so nullify the effect of reinstatement of actual opiate use, include naloxone, naltrexone and nalorphine. A typical opiate substitute, used in a maintenance programme, is methadone. Compounds such as agonists or substitutes for the addictive substance are administered in accordance with their normal regimes. Those skilled in the art will be able to devise suitable means for administering the alpha-2 adrenergic receptor agonist, which may be salt form or pro-drug form. The precise method adopted will depend on the material selected examples of possible administration routes may be oral, nasal, transdermal, ip and iv. The active compound will normally be employed in the form of a pharmaceutical composition in association with a pharmaceutical carrier, diluent and/or excipient, although the exact form of the composition will naturally depend on the mode of administration. Administration by transdermal patches is psychologically advantageous in providing addicts with a visible or touchable reminder that medication is being provided. Such patches are prepared in conventional manner typically as a gel formulation containing a permeation enhancer. Compositions may be prepared by admixture and are suitably adapted for oral, parenteral or topical administration, and as such may be in the form of tablets, capsules, oral liquid preparations, powders, granules, lozenges, pastilles, reconstitutable powders, injectable and infiisable solutions or suspensions, suppositories and transdermal devices. Orally adrninisterable compositions are preferred, in particular shaped oral compositions, since they are more convenient for general use. Tablets and capsules for oral administration are usually presented in a unit dose, and contain conventional excipients such as binding agents, fillers, diluents, tabletting agents, lubricants, disintegrants, colourants, flavourings, and wetting agents. The tablets may be coated according to well known methods in the art. Suitable fillers for use include cellulose, mannitol, lactose and other similar agents. Suitable disintegrants include starch, polyvinylpyrrolidone and starch derivatives such as sodium starch glycollate. Suitable lubricants include, for example, magnesium stearate. Suitable pharmaceutically acceptable wetting agents include sodium lauryl sulphate. Solid oral compositions may be prepared by conventional methods of blending, filling, tabletting or the like. Repeated blending operations may be used to distribute the active agent throughout those compositions employing large quantities of fillers. Such operations are, of course, conventional in the art. Oral liquid preparations may be in the form of, for example, aqueous or oily suspensions, solutions, emulsions, syrups, or elixirs, or may be presented as a dry product for reconstitution with water or other suitable vehicle before use. Such hquid preparations may contain conventional additives such as suspending agents, for example sorbitol, syrup, methyl cellulose, gelatin, hydroxyethylcellulose, carboxymethyl cellulose, aluminium stearate gel or hydrogenated edible fats, emulsifying agents, for example lecithin, sorbitan monooleate, or acacia; non-aqueous vehicles (which may include edible oils), for example, almond oil, fractionated coconut oil, oily esters such as esters of glycerine, propylene glycol, or ethyl alcohol; preservatives, for example methyl or propyl p-hydroxybenzoate or sorbic acid, and if desired conventional flavouring or colouring agents. For parenteral administration, fluid unit dose forms are prepared containing a compound of the present invention and a sterile vehicle. The compound, depending on the vehicle and the concentration, can be either suspended or dissolved. Parenteral solutions are normally prepared by dissolving the active compound in a vehicle and filter sterilising before filling into a suitable vial or ampoule and sealing. Advantageously, adjuvants such as a local anaesthetic, preservatives and buffering agents are also dissolved in the vehicle. To enhance the stability, the composition can be frozen after filling into the vial and the water removed under vacuum. Parenteral suspensions are prepared in substantially the same manner except that the active compound is suspended in the vehicle instead of being dissolved and sterilised by exposure to ethylene oxide before suspending in the sterile vehicle. Advantageously, a surfactant or wetting agent is included in the composition to facilitate uniform distribution of the active compound. Compositions used in this invention may be formulated by conventional means for controlled or delayed release. More specifically, clonidine and lofexidine may suitably be administered in formulations previously used in the existing regimes to treat withdrawal symptoms. As is common practice, the compositions will usually be accompanied by written or printed directions for use in the medical treatment concerned. The composition is preferably presented as a unit dose composition. Those skilled in the art will be able to determine by routine experiment suitable dosage levels which will depend on the active material and administration route. It is anticipated that the dosages for use against reinstatement will be less than those used in treating withdrawal symptoms, for example, in the region of 0.6 to 3.2 mgs. in the case of Lofexidine. Lofexidine, clonidine and guanabenz are commercially available compounds. No toxic effects are anticipated in the use of these compounds in accordance with this invention. While the applicants do not wish to be bound by this theory, it is thought that the intervention between the brain noradrenergic (NE) system and the alpha-2 adrenergic receptor agonists gives rise to the beneficial effects of the invention. Non-limiting examples of the invention and control experiments will now be described by reference to the Figures of the accompanying drawings of which: Figure 1. Microdialysis - Prefrontal cortex and amygdala: Mean (±SEM) NE concentrations in 20 min dialysate samples in prefrontal cortex and amygdala. Animals were injected with either clonidine (0, 20, or 40 μg/kg, i.p.), lofexidine (0, 75, or 150 μg/kg, i.p.), or guanabenz (0 or 640 μg/kg, i.p.) at Time 0, and 40 min later were exposed to 10 min of intermittent footshock stress (0.6 mA). Significant Time by Dose interactions were obtained for the prefrontal cortex and amygdala after clonidine (F(16,192)=4.40, p<.0.01 and F(16,168)=2.03, p<0.03, respectively), lofexidine (F(16,168)=5.09 p<.0.01 and F(16,192)=2.09, p<.03, respectively), and guanabenz (F(8,120)=6.22, p<.001); different from high dose only, p<.05; + different from both other doses, p<.05. Figure 2. Clonidine - reinstatement of cocaine-seeking: (A) Mean (±SEM) number of responses (infusions + timeout responses) on the inactive and previously active levers in the 3 h after an i.p. injection of saline, exposure to 15 min of intermittent footshock stress (0.6 mA), or an i.p. priming injection of cocaine (20 mg/kg). (B) Mean (±SEM) number of responses on the previously active lever in each hour after a saline injection, exposure to footshock stress, or a priming injection of cocaine. Rats were pretreated with vehicle (0) (n=9) or 20 (n=8) or 40 (n=8) μg/kg clonidine, i.p., 40 min before the start of the seff-administration session. Lever presses were without consequence during the tests. * different from vehicle (0) condition, + different from other doses, p<.05. Figure 3. Lofexidine - responding for sucrose: Mean (±SEM) number of responses on the inactive and active levers 60 min after pretreatment with 0, 80, 120, 160 and 200 μg/kg lofexidine, i.p. (n=8). Responding on the active lever was reinforced with 0.18 ml of a 30% sucrose solution. * different from vehicle (0) condition, p<.05. Figure 4. Lofexidine - reinstatement: (A) Mean (±SEM) number of responses (infusions + timeout responses) on the inactive and previously active levers in the 3 h after an i.p. injection of saline, exposure to 15 min of intermittent footshock stress (0.6 mA), or an i.p. priming injection of cocaine (20 mg/kg). (B) Mean (±SEM) number of responses (infusions + timeout responses) on the previously active lever in each hour after saline injection, exposure to footshock stress, or a priming injection of cocaine. Rats were pretreated with vehicle (0) (n=9) or 50 (n=l 1), 100 (n=l 1), 150 (n=9), or 200 (n=9) μg/kg lofexidine, i.p., 60 min before the start of the self-administration session. Lever presses were without consequence during the tests. * different from vehicle (0) condition, + different from other doses, p<.05. Figure 5. Guanabenz - reinstatement of cocaine-seeking: Mean (±SEM) number of responses (infusions + time out responses) on the previously active lever during 3 h test sessions (no footshock and footshock; saline and cocaine) after pretreatment with 0 or 640 μg/kg guanabenz. Figure 6. Lofexidine — effect on alcohol self-administration Effects of pre-treatment with saline, 0.05 or 0.1 mg/kg of lofexidine on alcohol self-administration as shown by amount of alcohol self-administered in g/kg during a 1-hour operant session (left panel) or number of alcohol reinforcements obtained (right panel). Values presented are averages of two consecutive sessions. N=9-10 animals per group. *P<0.05 compared to saline control. Figure 7. Lofexidine — effect on extinction of alcohol self-administration Effects of pre-treatment with saline and lofexidine on extinction of alcohol self- aministration as measured by number of responses on the active lever across eight operant sessions. N=9-10 animals per group. *P<0.05 compared to saline treatment. Figure 8. Lofexidine — effect on reinstatement of alcohol self -administration Effects of pre-treatment with saline, 0.05, 0.1 and 0.2 mg/kg of lofexidine on reinstatement of alcohol-seeking as measured by responses on the active lever induced by exposure to 10-minutes of intermittent footshock stress. N=10-12 animals per group. # PO.05 compared to baseline or drug only conditions. *P<0.5 compared to saline shock condition. Figure 9. Lofexidine - effect on reinstatement of alcohol self-administration Effects of pre-treatment with saline, 0.05, 0.1 and 0.2 mg/kg of lofexidine on responses on the inactive lever induced by exposure to 10 minutes of intermittent footshock stress. N=10-12 rats per group. ACTIVITY AGAINST REINSTATEMENT OF HEROIN USE Euro. J. Neurosci., Vol. 12, pp 292-302, 2000, provides data indicating that clonidine is effective in reducing foot-shock-induced reinstatement of heroin-seeking in heroin- addicted rats. The disclosure of this paper is incorporated herein by reference. ACTIVITY AGAINST REINSTATEMENT OF COCAINE USE MATERIALS AND METHODS Experiment 1: Effects of clonidine, lofexidine and guanabenz on footshock-induced NE release Subjects The subjects were male Long-Evans rats (Charles River, Quebec) weighing 300-350 g at the beginning of the experiment. Throughout the experiment, animals were housed in a humidity- and temperature-controlled colony room on a reversed light-dark schedule (lights on 1730-0530 hours) and were given free access to standard laboratory rat chow and water. The experimental procedures followed the CCAC guidelines and were approved by the Animal Care Committee, Concordia University. Surgery Before surgery, rats were anaesthetized with sodium pentobarbital (65 mg/kg, i.p.) and were injected with atropine sulfate (0.6 mg/ml; 0.2 ml rat, SC) and antibiotic (Penlong, Rogar/STB Inc.; 0.1 ml/rat, i.m.). Guide cannulae (20 gauge; Plastics One) were implanted for subsequent insertion of dialysis probes; one was placed in PFC and one in AMG in opposite hemispheres. The animals used to study the effects of guanabenz received a single guide cannula aimed at PFC. The hemisphere into which the respective guide cannulae were implanted was counterbalanced across treatments. The stereotaxic coordinates used (relative to bregma and skull surface) were as follows: AMG, AP -3.0 mm, ML ±4.5 mm, DV -6.7 mm; PFC, AP +3.2 mm, ML ±0.5 mm, DV -1.5 mm (Paxinos and Watson, 1997). Upon insertion, the shaft of the dialysis probe extended 1 mm from the guide cannulae. Implanted guide cannulae were secured to the skull with stainless steel screws and dental cement. Guide cannulae were closed with screw-in obdurators. All animals were returned to the colony room for a recovery period of no less than 1 week prior to testing. Microdialysis Microdialysis was conducted in four hexagonal testing chambers (42 x 39 x 33.5 cm) built from Plexiglas with wooden ceilings and stainless steel rod floors. Dark curtains were drawn around each chamber and lighting was provided on a reversed cycle by overhead light bulbs (15 W). The dialysis probe consisted of a 1.8 mm (AMG) or 3.5 mm (PFC) length of semipermeable dialysis membrane (Spectra/Por; 240 μm o.d., 13000 M.W. cutoff), closed at one end and attached at the other to a 19 mm length of 26 gauge stainless-steel tubing. A 40- to 50-cm length of PE-20 tubing connected the other end of the stainless steel shaft to an infusion swivel stationed above the testing chamber that was in turn connected via PE-20 tubing to a variable-speed infusion pump. A small diameter, fused-silica tube extended internally through the probe, with one end resting 0.5 mm from the tip of the probe and the other end exiting the PE tubing 35 cm below the infusion swivel. The external length of PE-20 tubing was protected from damage by steel spring casings. The probes were designed so that the entire length of semi-permeable membrane extended below the guide cannula tip. Separate squads of animals were used to examine the effects of each of the drugs tested. Within each squad, each animal was randomly assigned to the treatment condition. Animals that received vehicle injections were run in each squad, but were combined into a single group for statistical analysis. Final group sizes (PFC/ AMG) were as follows: vehicle (n = 15/17), clonidine 20 μg/kg (n = 7/6), clonidine 40 μg/kg (n = 9/5), lofexidine 75 μg/kg (n=6/6), lofexidine 150 μg/kg (n = 5/6), guanabenz 640μg/kg (n = 4, PFC). With the exception of the animals receiving guanabenz, all subjects were dialyzed twice, once in the PFC and once in the AMG with an interval of 3-4 weeks between tests. The probes were inserted the day before the beginning of microdialysis testing. To prevent occlusion, artificial CSF (145 mM Na + , 2.7 mM K + , 1.22 mM Ca 2+ , 1.0 mM Mg 2+ , 150 mM Cl", 0.2 mM ascorbate, 2 mM Na 2 HPO 4 , pH 7.4 ± 0.1) was perfused overnight at a rate of 0.06 μl/min. Dialysate sampling and activity monitoring began the next morning. The dialysate flow rate was increased to 0.6 μl/ min, and baseline dialysate samples (— 12 μl/ sample) were collected every 20 min. Samples were collected until a stable baseline, defined as a miiώ um of 3 consecutive samples in which dialysate NE levels varied by ±10%, was achieved. Following the establishment of stable baseline NE levels, all animals received an i.p. injection (1 ml/kg) of the appropriate drug or vehicle which was given 40 min before a 10 min period of footshock. Shocks were delivered on a variable time schedule at a mean interval of 40 s (10-70 s range); each shock (0.6 mA) was 0.5 s in duration. Samples were collected for a further 120 min (6 samples). Samples were immediately analyzed using one of two similar high-performance liquid chromatography systems with electrochemical detection (HPLC-EC). The samples (10 μl) were loaded onto reverse-phase columns (15 x 0.46 cm; HAISIL C18, 5 μm; Sci. Products & Equipment, Concord, Ontario) through manual injection ports (Reodyne 7125; 20 μl loop); reduction and oxidation currents for NE, dihydroxyphenylacetic acid (DOPAC), 5-hydoxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA) were measured with dual-channel ESA coulometric detectors (Coulochem 5100, with a model 5021 conditioning cell and a model 5011 analytical cell, Sci. Products & Equipment). The currents for NE were measured independent of those for DOPAC and HVA using separate channels of the Coulochem detectors. The mobile phases (sodium acetate 36 mM, SOS 3.1 mM, EDTA 100 μM, 5% acetonitrile, adjusted to pH 3.7 using glacial acetic acid) were circulated through each closed system at a flow rate of 1.4 rnl/min by Waters 510 FfPLC pumps. The peaks obtained for NE, DOPAC and HVA were integrated and quantified by EZChrom Chromatography Data System (Sci. Products & Equipment). Dialysate samples from individual rats always were analyzed with the same HPLC-EC system, and the assignment of animals to each system was counterbalanced across all treatment groups. Food was removed from the chambers before sampling, but a water drinking tube was available. At the completion of testing, confirmation of correct probe placement was determined by examination of 30 μm sections cut through the sites of probe placement stained with Cresyl violet. Experiment 2: Effects of clonidine on footshock- and cocaine-induced reinstatement Subjects The subjects were 25 male Long-Evans rats (Charles River, Quebec) weighing 350- 425 g at the start of the experiment. The animals were maintained as described in Experiment 1. Surgery Animals were prepared for surgery as described in Experiment 1. An intravenous catheter (Dow Corning) was implanted in the right jugular vein. A 3 -cm length of silastic tubing was inserted into the vein (inner diameter 0.30 mm, outer diameter 0.64 mm) and was connected with heat shrink tubing to a 9-cm length of silastic tubing (inner diameter 0.51 mm, outer diameter 0.94 mm) that was passed subcutaneously to the top of the skull. The catheter was secured to the vein with silk sutures and exited into a connector (a modified 22 gauge cannula; Plastics One, Roanoke, VA) that was mounted to the skull with jeweler's screws and dental cement; a plastic cap was placed over the opening of the cannula. Animals were allowed 1-2 weeks to recover from surgery. Apparatus The self-administration chambers used in the experiments were equipped with a retractable lever (Med Associates, St Albans, VT) and a non-retractable "dummy" lever. Both levers were located 9 cm above the floor. An infusion pump (Razel Scientific Instruments, Stamford, CT) was activated by responses on the retractable, or "active," lever. Responses on the dummy lever were recorded but did not result in activation of the pump. Drug solution was delivered over a 10-s period in a volume of 65 μl. Throughout the infusion period, a white stimulus light just above the active lever was illuminated and additional responses during this time were recorded, but did not result in reactivation of the pump. Each self-administration chamber was fitted to deliver constant-current, intermittent, inescapable, electric footshock through a scrambler to the grid floor (Grason-Stadler Generator #E1064GS). The footshock was delivered for 15 min according to a variable time schedule at a mean interval of 40 s (10-70 s range). Each shock (0.6 mA) was 0.5 s in duration. This intensity of footshocks has been found using our apparatus to be the minimal required to induce reliable reinstatement. Drugs Cocaine HC1 was obtained from BDH Chemicals (Toronto, Canada) and was dissolved in physiological saline. Clonidine HC1 was purchased from Sigma (St Louis, MO) and was dissolved in physiological saline and injected i.p. (0, 20, and 40 μg/kg). Procedure Phase 1: Training. Rats were trained to self-administer cocaine HC1 (0.5 mg/kg/infusion, i.v.) on a fixed-ratio-1 schedule of reinforcement during one daily 3-h self-administration session. Each day, half of the animals were brought to the operant chambers for their self-administration session in the morning, approximately 3 hours after lights off, and half of the animals were brought to the chambers in the afternoon, approximately 7 hours after lights off. The group of animals assigned to the morning and afternoon sessions alternated daily so that by the end of training all animals had received an equal number of self-administration sessions at both times. It was important that all animals had similar experience self-administering early and late in the day since during Phase 2 all animals received extinction sessions in the morning followed by a test session that typically occurred in the afternoon. At the beginning of each session, a red house light was illuminated for 10 s before introduction of the retractable lever into the cage. The light just above the active lever was lit for the initial 30 s following presentation of the lever. The house light remained illuminated throughout the session. As indicated previously, responses on the active lever resulted in activation of the infusion pump and illumination of the light above the lever for the 10 s of drug delivery. Additional lever presses during the drug-delivery period were recorded but did not result in reactivation of the pump. Training conditions were in place for 10 to 12 days. At the end of training, animals were left undisturbed in the colony room for 7 to 13 days. Subsequently, extinction and testing took place. In this experiment and in Experiment 3B, groups of animals were assigned to different doses of the test drugs. All animals in each group were then subjected to three test conditions; saline, cocaine and footshock. Phase 2: Extinction and testing. During extinction and testing, which occurred over 4 consecutive days, animals were housed 24 h per day in the self-administration chambers. Food and water were freely available to animals, except during daily extinction and test sessions. Animals were brought to the chambers in the evening preceding the first day of extinction and testing. Since two separate groups of rats were run each day during the training phase, one group of animals was tested in the first 4 days of Phase 2 and the other group of animals was tested in the next 4 days. During extinction and testing, all of the conditions that were present during training were maintained except that lever presses did not result in cocaine infusions. In this and all subsequent reinstatement experiments, animals were given several daily 1-h extinction sessions separated by intervening periods in which the lever was withdrawn. On day 1, animals were given 4 extinction sessions; on days 2-4, animals were given 2 to 3 extinction sessions, sufficient to establish a baseline level of responding of 15 or fewer responses in 1 h, followed by a 180 min test session. The duration of the intervening periods was kept constant for each experiment and corresponded to the delay required for drug absorption between pretreatment injections and the start of the test. In the present experiment, the duration of intervening periods was 40 min. At test, separate groups of animals were pretreated with either 0, 20, or 40 μg/kg, i.p., clonidine before each of three tests for reinstatement (saline, cocaine, and footshock), given on consecutive days and in a counterbalanced order. Clonidine was injected 40 min before the lever was inserted. For the saline and cocaine priming tests, animals were given a non-contingent, i.p., injection of saline or cocaine (20 mg/kg) 5 min before lever insertion. For the footshock tests, animals were exposed to the 15-min brief intermittent footshock stress immediately before insertion of the lever. Experiment 3 A: Effects of lofexidine on high rates of responding for sucrose Because the pharmacological profile for lofexidine has not been as well characterized as that for clonidine, an experiment was conducted to establish whether, and at what doses, lofexidine induces performance deficits. The doses in the tests for reinstatement were chosen on the basis of results obtained in this experiment. Subjects The subjects were 8 male Long-Evans rats (Charles River, Quebec) weighing 400-550 g at the beginning of the experiment. Rats were previously used in an experiment aimed at studying footshock-induced reinstatement of sucrose seeking. Animals were maintained under similar conditions to those described in Experiment 1. Apparatus Each self-administration chamber was equipped with two stationary levers, symmetrically centered on one side panel, 5 cm above the floor. Responses on one lever, the "active" lever, activated a pump (Razel Sci. Stamford, CT). Responses on the other lever, the "dummy" lever, were recorded but were without consequence. Activation of the pump resulted in a 20 s delivery of 0.18 ml sucrose solution to a liquid drop receptacle located between the two levers. Throughout the sucrose delivery period, a white stimulus light just above the active lever was iUuminated and additional responses during this time were recorded but did not result in reactivation of the pump. Drugs Lofexidine HC1 was supplied by Britannia Pharmaceuticals Ltd., UK. The drug was dissolved in physiological saline and injected i.p. (0, 80, 120, 160 or 200 μg/kg). Procedure Animals that had previously learned to self-administer sucrose were subsequently given 5 sessions over 5 consecutive days in which they self-administered a 30% sucrose solution on an FR-1 schedule. In subsequent daily sessions, animals were injected with either vehicle (0 μg/kg) or lofexidine (80, 120, 160 or 200 μg/kg, i.p.) 60 min before the start of the self-administration session. All animals received all doses of lofexidine in a counterbalanced order; the highest dose of lofexidine was tested twice. Each session in which animals were treated with lofexidine was followed by a saline pretreatment session to minimize the possibility of carry-over effects of the drug. Experiment 3B: Effects of lofexidine on footshock- and cocaine-induced reinstatement Subjects The subjects were 49 male Long-Evans rats (34 from Charles River, Quebec; 15 from Harlan Sprague Dawley, USA) weighing 350-400 g at the beginning of the experiment. The animals were maintained as described in Experiment 1. There were no obvious differences in responding between animals from the two suppliers in any phase of the experiment. Procedure Phase 1: Training. Animals were trained to self-administer cocaine under the conditions described in Experiment 2. Phase 2: Extinction and testing. In this experiment the intervening periods, as described above, were 60 min in duration. At test, separate groups of animals were pretreated with either 0, 50, 100, 150, or 200 μg/kg, i.p., lofexidine before each of three tests for reinstatement (saline, cocaine, and footshock stress), given on consecutive days and in a counterbalanced order (see Experiment 2). Lofexidine was injected 60 min before the insertion of the lever. Test sessions were 3-h in duration. The doses of lofexidine were chosen on the basis of the results obtained in Experiment 3A. Experiment 4: Effects of guanabenz on footshock- and cocaine-induced reinstatement Subjects The subjects were 18 male Long-Evans rats (Charles River, Quebec) weighing 350- 400 g at the beginning of the experiment. The animals were maintained as described in Experiment 1. Drug Guanabenz was purchased from Sigma (St Louis, MO) and was dissolved in physiological saline and injected i.p. (0, and 640 μg/kg). Procedure Phase 1: Training. Animals were trained to self-administer cocaine under the conditions described in Experiment 2. Phase 2: Extinction and testing. In this experiment the intervening periods, as described above, were 60 min in duration. At test, animals were pretreated with 0 or 640 μg/kg guanabenz, i.p., before each of two tests for reinstatement (no footshock, footshock or saline, cocaine), given on consecutive days (see Experiment 2). Guanabenz was injected 60 min before the insertion of the lever. Test sessions were 3-h in duration. The dose of guanabenz was chosen on the basis of its substitutability for 40 μg/kg clonidine in a drug discrimination procedure. Statistical analyses Microdialysis data were analyzed using a mixed-factor ANOVA for concentration of extracellular NE in 20 min dialysate samples; the between-subjects factor was dose of clonidine (0, 20, 40 μg/kg), lofexidine (0, 75, or 150 μg/kg), or guanabenz (0 or 640 μg/kg) and the repeated measure was time. Significant time by dose interactions were subjected to one-way ANOVAs for the factor of dose at specific time points. When appropriate, post hoc tests (Fisher's LSD, p<.05) were conducted to compare vehicle (0 μg/kg) to drug conditions. The two dependent measures in the tests for reinstatement were number of responses on the active lever (infusions + time out responses) and number of responses on the inactive lever in 3 h. All behavioral data are presented as means ± SEM. Because of considerable variability in the number of responses made in the different tests for reinstatement, the non-parametric statistics for related (Friedman and Wilcoxon) and unrelated (Kruskal-Wallis and Mann-Whiney) samples were used where appropriate. For the sucrose study (Experiment 3 A) the dependent measures were the number of responses on the active (reinforced + timeout responses) and inactive levers and the number of reinforcements obtained. Repeated measures ANOVAs were conducted with Dose as the within-subject factor. When appropriate, post hoc tests (Fisher's LSD, p<.05) were conducted to compare vehicle (0 μg/kg) to drug conditions. RESULTS Experiment 1: Effects of clonidine, lofexidine and guanabenz on footshock-induced NE release Figure 1 shows basal and footshock-induced levels of NE in PFC (top row) and/or AMG (bottom row) after injection at Time 0 with clonidine (left panel), lofexidine (center panel), or guanabenz (right panel). Mixed-factor ANOVAs revealed significant Time by Dose interactions in both brain regions and for each of the three drugs. The statistics for each of these interactions are indicated in the figure legend. One-way ANOVAs conducted at specific time points were, when statistically significant, followed by post-hoc comparisons (Fisher's LSD). Significant differences are indicated in Figure 1. Experiment 2: Effects of clonidine on footshock- and cocaine-induced reinstatement Training and Extinction The mean (±SEM) number of infusions of 0.5 mg/kg cocaine made in the 3-h session on the last two days of training was 32.24 (±2.77) and 25.76 (±2.96), respectively. The mean (±SEM) number of responses (infusions + time out responses) made during the first three 1-h extinction sessions on day 1 of Phase 2, was 28.92 (±2.81), 13.16 (±2.03), and 9.68 (±2.04). There was no difference in the rate of extinction between animals tested in the first 4 days of Phase 2 and those tested 4 days later. Tests for reinstatement The number of responses made on the active and inactive levers during each 3-h test for reinstatement following pretreatment with clonidine is shown in Figure 2A. Figure 2B shows the number of responses on the active lever during each hour of testing. It can be seen that pretreatment with 20 or 40 μg/kg clonidine blocked footshock-induced relapse to cocaine seeking, but had no effect on relapse induced by a priming injection of cocaine. Kruskal-Wallis tests conducted at each hour of testing revealed a significant effect of dose of clonidine in the footshock condition in Hour 1, when most of the responding occurred (X 2 (2)=6.0, p<.05, footshock); both doses of clonidine were effective (ps<.05). There were no significant effects of clonidine in either the saline or cocaine conditions in Hour 1 ; no effects were seen in any of the test conditions in Hours 2 or 3. Figure 2 A shows that responding on the inactive lever was low under all pretreatment and test conditions. This was the case in all subsequent reinstatement experiments, where there were no significant effects of the number of responses on the inactive lever. Experiment 3 A: Effects of lofexidine on responding for sucrose Figure 3 shows the total number of responses (reinforced + time out responses) on the active and inactive levers, and the number of sucrose reinforcements made, following injections of vehicle (0 μg/kg) or lofexidine. There was no effect of lofexidine on the number of responses on the active lever, F(4,28)=l .79, ns. There were, however, Dose effects on the number of reinforcements and number of responses on the inactive lever, F(4,28)=2.80, p<0.05 and F(4,28)=2.85, p<0.05, respectively; this reflects the fact that when compared with the vehicle (0 g/kg) condition, animals obtained fewer sucrose reinforcements and made fewer responses on the inactive lever following pretreatment with the highest dose of lofexidine (200 μg/kg). Experiment 3B: Effects of lofexidine on footshock- and cocaine-induced reinstatement Training and Extinction The mean (±SEM) number of cocaine infusions made in the 3-h session on the last two days of training was 30.07 (±2.37) and 30.91 (±2.06), respectively. On day 1 of extinction, the mean (±SEM) number of responses made in the first three 1-h extinction sessions (infusions + time out responses) was 31.32 (±3.22), 16.84 (±3.29), and 16.23 (±2.35). There was no difference in the rate of extinction between animals tested in the first 4 days and those tested in the subsequent 4 days of Phase 2. Tests for reinstatement Figure 4 A shows the number of responses made on the active and inactive levers during each 3-h test for reinstatement following pretreatment with vehicle (0 μg/kg) or lofexidine. Figure 4B shows the number of responses on the active lever during each hour of testing. It can be seen that both footshock stress and priming injections of cocaine induced reinstatement of cocaine seeking behavior. Only the effect of footshock stress was attenuated by lofexidine. This is confirmed by the Kruskal- Wallis tests conducted for the 3-h tests for reinstatement where the only significant effect was found in the footshock condition (X 2 (4)=10.50, p<.05). Subsequent Mann- Whitney comparisons revealed a significant difference between the 0 and 150 μg/kg and 0 and 200 μg/kg lofexidine doses (ps<.05); furthermore, the response to footshock after 150 and 200 μg/kg doses did not differ from the responses in the saline condition. Separate analyses conducted at each hour of testing revealed a significant effect, again, only in Hour 1 of testing (X 2 (4)=17.31, p<.01, footshock), when all doses of lofexidine blocked the footshock effect (ps<.05). Experiment 4: Effects of guanabenz on footshock- and cocaine-induced reinstatement Training The mean (±SEM) number of infusions of cocaine made in the 3-h session on the last two days of training was 36.63 (±3.56) and 40.12 (±3.65), respectively. Tests for reinstatement Figure 5 shows the number of responses made on the active lever in tests for reinstatement after pretreatment with either 0 or 640 μg/kg guanabenz. It can be seen that guanabenz attenuated the effect of footshock stress. A Friedman analysis on the footshock and no footshock tests revealed a significant effect of test condition, X 2 (3)=8.36, p<.05, and subsequent comparisons using the Wilcoxon test showed that the footshock (0 μg/kg) condition differed from the others (ps< .05). Inspection of Figure 5 also reveals what appears to be a reduction in responding in the cocaine test following pretreatment with guanabenz. However, a comparison of the scores on the cocaine test using the Mann- Whitney revealed no significant difference between the two groups (0 and 640μg/kg; z=0.73, p= 46). Systemic injections of clonidine and lofexidine attenuate the footshock-induced reinstatement of cocaine seeking, but have no effect on reinstatement induced by priming injections of cocaine. Second, the alpha-2 adrenergic receptor agonist, guanabenz, which unlike clonidine and lofexidine has a low affinity for Ii receptors also attenuates footshock-induced reinstatement. These effects were obtained by drugs that at similar doses and under similar stress parameters to those used in the tests for reinstatement suppressed the footshock-induced increase in NE release in AMG and or PFC in naϊve animals. These findings suggest that reduction of brain NE activity may be an effective way to prevent stress-induced relapse to cocaine seeking. The effects of clonidine and lofexidine observed in this study could have been mediated through their actions at Ii rather than alpha-2 receptors. The nM affinity of clonidine for the alpha-2 receptor is 28±2.6 and for the L receptor is 0.99±0.43; the affinity of lofexidine for these receptors is almost identical. Alpha-2 and l\ receptors have been shown, however, to be differentially involved in biochemical and behavioral effects of alpha-2 adrenergic receptor agonists. For example, in drug discrimination studies, alpha-2 receptors appear to be responsible for a clonidine- induced cue, for which both lofexidine and guanabenz (a compound with nM affinity for alpha-2 receptor of 7.2±0.6 and for the Ii receptor of >1, 000,000) substitute dose- dependently. On the other hand, Ii receptors of the medulla are thought to mediate the antihypertensive actions of these drugs. Although not definitive in view of the fact that guanabenz was not tested independently for rate-reducing effects, it appears unlikely that the attenuation of the footshock-induced reinstatement of cocaine seeking was I receptor mediated; guanabenz, a drug with a low affinity for the l\ receptor, attenuated footshock-induced reinstatement of cocaine-seeking at a dose that has been shown to substitute for 40 μg/kg clonidine in a drug discrimination task. Three issues might be seen to complicate the interpretation of the present findings. First, clonidine, lofexidine and guanabenz might affect motor performance; second, these drugs might act at peripheral rather than central receptors; and finally, it is possible that the analgesic actions of these drugs mediate their effect on footshock- induced reinstatement. With respect to the first, it is unlikely that the effects were due to a performance deficit. In the saline and cocaine priming conditions, neither clonidine, lofexidine nor guanabenz reduced responding on the active lever. Furthermore, the doses of clonidine and lofexidine used in the tests for reinstatement were chosen because they had little or no effect on high rates of responding for sucrose. After the highest dose of clonidine tested (40 μg/kg) in sucrose-trained animals, animals responded nearly 100 times in 20 min; likewise, in Experiment 3 A, animals injected with the highest dose of lofexidine (200 μg/kg) obtained close to 40 reinforcements in 30 min and demonstrated no significant reduction in response rate. The possibility that the effects observed in the present study were due to the actions of the alpha-2 agonists at peripheral rather than central receptors also seems unlikely. First, we found in a study with heroin-trained rats that i.e. v. injections of clonidine were as effective as systemic injections in blocking the footshock-induced reinstatement. Additionally, systemic injections of 40 μg/kg ST-91 (the charged analogue of clonidine which does not effectively cross the blood brain barrier) have been given to cocaine-trained animals. The ST-91 -treated animals show a comparable footshock-induced reinstatement of responding (90.75 ± 26.37 in 3 hr) to vehicle- treated animals (115.63 ± 24.49 in 3 hr). It would appear, therefore, that the effects of systemic injections of clonidine on footshock-induced reinstatement of both heroin and cocaine seeking are mediated centrally. ACTIVITY AGAINST REINSTATEMENT OF ETHANOL USE MATERIALS AND METHODS Animals: Male Wistar rats (Charles River, Montreal; weighing about 150-200 g. at the start of the experiments) were individually housed. Food and water were freely available in the home cages for 23 h/day. Food was not available during the 30 to 60 min daily session (see below). The temperature was maintained at 21± 1°C and the lights were on from 7 a.m. to 7 p.m. Rats were initially trained to consume alcohol in a limited access procedure (Linseman, 1987). The rats were given access to an alcohol solution and water in modified Richter tubes for 30 min/day in drinking cages. Alcohol solutions were provided in escalating concentrations: 3% w/v for the first 5 days 6% for the next 8 days and 12% for the last 10-12 days. Rats that consumed less than 0.4 g/kg per session during the last 10-12 days were excluded. All procedures were done in accordance with the guidelines of the Canadian Council on Animals Care and the 'principle of laboratories animal care' (NIH publication No. 85-23, revised 1985), and were approved by the local Animal Care Committee. Apparatus: The alcohol self-administration system was built locally. Each operant chamber was equipped with two levers, symmetrically centered on the side panel. Responding on one lever (the active lever) activated the infusion pump (Razel Sci. Stamford, Conn., USA). Presses on the other lever (the inactive lever) were recorded, but did not activate the pump. Activation of the pump resulted in the delivery of 0.19 ml of 12% w/v alcohol solution to a liquid drop receptacle located between the two levers over a period of 5 s. During the infusion, a stimulus light above the active lever was turned on for 6 s. Lever presses during this 'time out' period were counted, but did not lead to further infusions. The grid floor of the operant cambers was connected to electric shock generators (Med Associates, Georgia, V , USA). Training and extinction of alcohol self-administration: Operant self-administration of alcohol was initiated on a fixed ration- 1 schedule of reinforcement (FR-1, each lever press is reinforced) for 60 min per day for 5-7 days per week. Responding on the FR-1 schedule was maintained for 10-14 sessions. The requirement for alcohol delivery was then increased to FR-2 for five sessions. Subsequently, the schedule requirement was increased to an FR-3 schedule for 8-12 days until the rats obtained three days of stable drug taking (variability of less than 20% of the mean). During extinction sessions, presses on the previously active lever had no programmable consequences. Test for reinstatement commenced after five to eight extinction sessions, when the rats reached the extinction criterion of fewer than 12 presses on the active lever per 60 min. Test for Reinstatement: Tests were conducted under extinction conditions. Intermittent footshock (0.8 mA; 0.5 s ON; a mean OFF period of 40 s; a range of 10- 70 s) was administered for a period of 10 min just prior to the test sessions. Footshock was delivered through a scrambler to the stainless steel grid floor of the operant chambers. Drug: Lofexidine HCL was provide by Britannia Pharmaceuticals Ltd. The drug was dissolved in saline and injected IP in a volume of 1 ml per kg. Lofexidine pre- treatment was given one hour prior to the start of the operant sessions. Experiment 5 : Effects of Lofexidine on alcohol self-administration and extinction This experiment was designed to examine the effect of different doses of lofexidine on alcohol self-administration and extinction of alcohol self-administration behaviour. Three groups of rats trained to attain a stable and high level of alcohol self- administration were used. One group of rats received saline treatment while rats from the other two groups received 0.1 and 0.05 mg/kg of lofexidine treatment one hour prior to the operant session. The effect of lofexidine on alcohol self-administration was examined on two consecutive sessions. Animals received IP injection of saline 1 hour prior to the operant session for three sessions prior to testing to habituate the animal with the injection procedure. All rats then received daily injection with saline 60 min prior to the operant sessions for 4 days. To examine the effect of lofexidine on extinction of ethanol self- administration behaviour, rats received daily treatment with lofexidine (0.05 or 0.1 mg/kg) or saline one hour prior to their daily operant session. During this phase, responding on the active lever did not result in any alcohol delivery. Experiment 6 : Effect of Lofexidine on footshock reinstatement of alcohol seeking Three groups of rats (n=10 each) which attained stable alcohol self-administration were used for this study. When the animals achieved extinction criterion, the effect of pre-treatment with lofexidine on footshock stress-induced reinstatement of alcohol seeking was determined as described above. Rats from group 1 received saline while rats from group 2 and 3 received treatment with 0.05 or 0.1 mg/kg of lofexidine 1 hour prior to exposure to footshock stress. Data Analysis Analysis of variance with or without repeated measures were employed to analyse the data. Where appropriate, post-hoc Newman Keuls' t tests were used. In the first experiment, the average amounts of alcohol self-administered over a period of two days were used to quantify the effects of lofexidine treatment on alcohol self- administration. Such data are expressed in terms of g/kg of alcohol consumed by the animals during the 1-hour session. This data is derived from multiplying the amount of alcohol delivered per reinforcement (23.8 mg of alcohol) with the number of reinforcement obtained and divided by the animal body weight. The number of responses on the active lever are used to assess the rate of extinction and the effects of lofexidine on extinction rate. This parameter is also used to assess the effects of footshock stress on reinstatement of alcohol seeking. RESULTS Experiment 5 : Figure 6 shows the average alcohol seff-administration in various experimental groups over two days of lofexidine or saline treatment. As seen from this figure, rats self-administered an average of about 1.4 g kg during their daily 1- hour session. Analysis of variance reveals a significant treatment effect (F=9.05, df=2,28) which indicates that lofexidine treatment affects alcohol self-administration. Post-hoc Newman-Keuls tests show that alcohol seff-administration in rats treated with 0.1 mg/kg of lofexidine was significantly lower (p<0.05) than those of the saline or 0.05 mg/kg lofexidine treated group. Similar tests show no significant differences in the amount of alcohol self-administration between the saline and 0.05 mg/kg lofexidine group. These results indicate that pre-treatment with 0.1 mg/kg but not 0.05 mg/kg of lofexidine significantly reduced alcohol self-administration. The effect of lofexidine pre-treatment on the rate of extinction of ethanol self- administration behaviour as measured by the number of responses on the active lever is shown in Figure 7. An overall analysis of variance comparing the responses on the active lever of various groups on the last session prior to extinction and the 7 extinction sessions reveals a significant Group x Day interaction (F=2.35, df=14, 184, p<0.01) which indicates that the rates of change in the response on the active lever across different sessions varied with the treatment. Since the reduction in responses on the active lever was at maximal by the second session of extinction, an analysis of variance was carried out to examine the responses on the last session prior to extinction and the first two extinction sessions. Post-hoc Newman-Keuls tests show no significant differences in the number of responses on the active lever between the 0.05 mg/kg and 0.1 mg/kg lofexidine treated group on the last session prior to extinction. The responding on both lofexidine treated groups on this session, however, was significantly higher than the saline treated group. On the first day of extinction, responding on the active lever in the 0.1 mg/kg treated group was significantly lower than that of the 0.5 mg/kg and the saline treated group. There were no significant differences in responding on the active lever among the three groups by the second day of extinction. These results indicate that treatment with 0.1 mg/kg of lofexidine might facilitate extinction of alcohol self-administration behaviour. Experiment 6: The effects of pre-treatment with saline and various doses of lofexidine on footshock stress induced-responding on the active and inactive levers are shown in Figure 8 and Figure 9 respectively. Exposure to footshock stress potently reinstates alcohol seeking in the saline treated group as indicated by an increase in responding on the active lever. Pre-treatment with 0.05, 0.1 or 0.2 mg/kg of lofexidine significantly suppressed reinstatement of alcohol seeking. An analysis of variance comparing the responses of various groups on the active bar showed a significant effect of treatment (F=3.53 df=3.38, p<0.02). Post-hoc tests show that the responses on the active lever of all the lofexidine treated groups following exposure to footshock were not different from one another. They are, however, all significantly below that of the saline treated group (p<0.05). These results indicated that all doses lofexidine suppressed reinstatement of alcohol seeking. Such exposure to footshock stress did not increase responding on the active lever in saline and various lofexidine treated groups as compared to their baseline responses (F=2.3, df=3.38, p=0.09). These results indicate that the increase in response to the active lever induced by footshock stress was not due to a generalized increase in activity. DISCUSSION The results of these studies confirm and extend previous observations that with prior exposure to alcohol drinking in a limited access paradigm rats will readily self- administer alcohol in an operant paradigm. Rats self-administer an average of 1.2-1.3 g/kg during 1-hour operant session. The amount of alcohol seff-administered exceeded the metabolic capacity and produced significant blood alcohol levels (average of 55 mg%, with a range). The present study demonstrated that treatment the alpha-adrenergic receptor agonist, lofexidine can reduce alcohol self- administration; tended to facilitate extinction of alcohol self-administration behaviour and also attenuated stress-induced relapse to alcohol seeking behaviour. Pre-treatment with lofexidine at a dose of 0.1 mg/kg significantly suppresses alcohol self-administration as measured over two consecutive days of treatment. A reduction in alcohol self-administration was also observed with the lower dose of lofexidine. Such effects, however, did not reach statistical significance. Our findings are consistent with reports of a reduction in alcohol consumption by pre-treatment with various α-2-adrenergic receptor agonists such as clonidine, guanfacine and tiamedine. It is possible that the decrease in central noradrenergic activity induced by lofexidine or clonidine might account for its action in reducing alcohol seff-administration. Studies which examined the effects of lesioning central noradrenergic systems on alcohol consumption, have produced some conflicting results. For example, depletion of brain noradrenaline has been shown to increase or decrease alcohol consumption in rats. It has also been suggested that an intact noradrenergic system is necessary to maintain alcohol consumption. The present findings with lofexidine, a drug that produces minimal hypotensive effect, on operant self-administration of alcohol suggest that the brain noradrenergic systems might play a role in the rewarding effects of alcohol. Although, all rats received a similar pre-treatment with saline on the last day of alcohol seff-administration, the responding on the active lever of the designated saline treated group was significantly lower than those of animals designated to receive 0.05 and 0.1 mg/kg treatment. We do not have any explanation for such a difference. However, responses on the active lever were essentially the same in both the 0.05 and 0.1 mg/kg groups. There was a significant decrease in the number of bar presses on the active lever in rats treated with 0.1 mg/kg of lofexidine as compared to the saline control or the 0.05 mg/kg treated group on day 1 of extinction. This suggests that lofexidine at a dose of 0.1 mg/kg facilitates extinction of alcohol self-administration behaviour. Such facilitation of the extinction of alcohol self-administration behaviour suggests that lofexidine reduces alcohol seeking or reduces the desire for alcohol. This interpretation would be consistent with the observation of a reduction in alcohol self-administration mentioned above. Alternatively, since the brain noradrenergic systems have been implicated in learning, one could suggest that the facilitation of extinction of alcohol self-administration might be due to an effect of lofexidine on learning i.e. extinction in a learned behaviour. However, it is unlikely that such learning factor plays any significant role on the observed effect of lofexidine as the maximal extinction effect was observed on the first day of lofexidine treatment. In agreement with our previous findings, exposure to intermittent footshock stress potently reinstates alcohol seeking after alcohol self-administration behaviour has been extinguished. Pre-treatment with lofexidine in doses ranging from 0.05 to 0.2 mg/kg completely suppressed reinstatement of alcohol seeking. Thus, it appears that stress-induced reinstatement of alcohol seeking is more sensitive to lofexidine than alcohol self-administration and extinction of such self-administration. Our findings concerning the effects of lofexidine on stress-induced reinstatement of alcohol seeking is similar to that reported above on reinstatement of cocaine seeking induced by exposure to stress. The attenuation of footshock stress-induced reinstatement of cocaine seeking, however, was observed with 0.150 mg/kg or 0.2 mg/kg doses of lofexidine. One of the possible factors that might confound the interpretation of the present work is that lofexidine might reduce alcohol self-administration, facilitate its extinction and block stress-induced reinstatement of alcohol seeking by impairing motor performance. It is unlikely that lofexidine affects various alcohol related behaviours by producing motor deficits. It is shown above that doses of lofexidine ranging from 0.08 mg to 0.2 mg/kg did not affect responding to 30% sucrose solution. Furthermore, doses of 0.15 mg/kg and 0.2 mg/kg of lofexidine did not affect responding on the active lever induced by cocaine priming but suppressed stress- induced reinstatement of cocaine seeking. Lofexidine, in doses employed in the present study have been shown to block stress induced NE release in the pre-frontal cortex as well as the amygdala. It is tempting to suggest that the observed effects of lofexidine on various alcohol related behaviours examined in the present study are due to its action on α-adrenergic receptors. However, we cannot rule out the possibility that lofexidine might also mediate its action through the imidazoline-type 1 (12) receptors as it also has high affinity for these receptors. Independent of its mechanism of action, the results of the present study point out that lofexidine might have important therapeutic applications for treatment of alcohol abuse. Its suppression of alcohol self-administration as well as its attenuation of stress-induced alcohol seeking observed in the present study strongly suggest further investigation for its use in alcohol relapse prevention. SUMMARY It seems unlikely that footshock-induced reinstatement of drug seeking is mediated by analgesic effects of these drugs at the doses used. Observations made during the footshock sessions revealed that both vehicle- and drug-pretreated animals reacted similarly to the footshocks throughout the shock period. These observations are consistent with the finding that clonidine, within a similar dose range to the one used in the present study, does not alter threshold sensitivity to footshock. In addition, the findings presented here indicate the utility of α-2 adrenergic receptor agonists, in particular lofexidine and clonidine, in treatment programs for the prevention of relapse to drugs of abuse. The current use of these drugs in the short- term treatment of acute opioid withdrawal, though useful, does not prevent relapse to drug use following its termination. According to the invention a more prolonged period of treatment is efficacious. Thus the invention provides a rationale for the use of alpha-2 adrenergic receptor agonists in treatment programs for the prevention of relapse to non-opiod drug use. Currently, these drugs are being used with some success in the short-term treatment of opioid withdrawal. The present findings surprisingly indicate utiliy in the treatment of cocaine and ethanol users if given for a more prolonged period. Also the present experiments surprisingly demonstrate a similar efficacy of clonidine and lofexidine in preventing footshock-induced reinstatement of cocaine seeking. This finding is of potential clinical significance in that lofexidine has been reported in humans to be associated with fewer adverse side effects than clonidine, in particular fewer hypotensive effects.

Claims: CLAIMS 1. A method of preventing or reducing stress-induced reinstatement of addictive material-seeking in a treatment regime which comprises treating a mammal addicted to an opiate by administering an effective amount of a narcotic antagonist, in which the existing therapy is carried out in combination with administration of an effective amount of an oc-2 adrenergic receptor agonist, a physiologically acceptable salt thereof or a pro-drug thereof. 2. A method according to claim 1 in which the narcotic antagonist is naloxone, naltrexone or nalorphine. 3. A method of preventing or reducing stress-induced reinstatement of addictive material-seeking in a treatment regime which comprise treating a mammal addicted to an opiate by administering an effective amount of an opiate substitute, in which the existing therapy is carried out in combination with administration of an effective amount of an oc-2 adrenergic receptor agonist, a physiologically acceptable salt thereof or a pro-drug thereof. 4. A method according to claim 3 in which the opiate substitute is methadone. 5. A method according to any one of claims 1 to 4 in which the oc-2 adrenergic receptor agonist is administered sequentially, simultaneously or conjointly with the narcotic antagonist or with the opiate substitute. 6. A method according to any one of claims 1 to 5 in which the alpha-2 adrenergic receptor agonist is lofexidine, clonidine or guanabenz. 7. A method according to any one of claims 1 to 6 in which the opiate is heroin. 8. A method of preventing or reducing stress-induced reinstatement of addictive material-seeking which comprises treating a mammal addicted to an non-opiate by administering an effective amount of an χ-2 adrenergic receptor agonist, a physiologically acceptable salt thereof or a pro-drug thereof 9. A method according to claim 8 wherein the alpha-2 adrenergic receptor agonist is lofexidine, clonidine or guanabenz. 10. A method according to claim 8 or 9 in which the non-opiate is cocaine, ethanol or nicotine. 11. The use of an alpha-2 adrenergic receptor agonist, a physiologically acceptable salt thereof or a pro-drug thereof, in the manufacture of a medicament for a method of treatment as defined in any one of claims 1 to 10. 12. The use of an alpha-2 adrenergic receptor agonist, a physiologically acceptable salt thereof or a pro-drug thereof, in the manufacture of a medicament for preventing or reducing the stress- related reinstatement of addictive material seeking, with the proviso that the addictive material is not heroin. 13. A use as claimed in claim 12 in which the addictive material is cocaine, nicotine or ethanol. 14. A use as claimed in claim 12 or 13 in which the alpha-2 adrenergic receptor agonist is lofexidine, clonidine or guanabenz. 15. The use of lofexidine or a physiologically acceptable salt or pro-drug thereof in the manufacture of a medicament for preventing or reducing the stress-related reinstatement of cocaine, nicotine or ethanol-seeking.

Inventors: DAVIES KEITH, LE DZUNG ANH, SHAHAM YAVIN, STEWART JANE, DAVIES, KEITH, LE, DZUNG, ANH, SHAHAM, YAVIN, STEWART, JANE
Applicants: BRITANNIA PHARMACEUTICALS LTD, DAVIES KEITH, LE DZUNG ANH, SHAHAM YAVIN, STEWART JANE, BRITANNIA PHARMACEUTICALS LIMITED, DAVIES, KEITH, LE, DZUNG, ANH, SHAHAM, YAVIN, STEWART, JANE
Application year: 2001
Main classification: A61K31
IPC codes: A61K31, A61P25