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Amphetamines Exacerbate then Ameliorate Respiratory Effects of Fentanyl as Their Dose Increases
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  • Harrison J. Elder,
  • Neil B. Varshneya, PhD,
  • D. Matthew Walentiny, PhD,
  • Patrick M. Beardsley, PhD
Harrison J. Elder
Department of Pharmacology & Toxicology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA

Corresponding Author:[email protected]

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Neil B. Varshneya, PhD
Department of Pharmacology & Toxicology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA, Center for Drug Evaluation and Research, Food and Drug Administration, United States Department of Health and Human Services, Silver Spring, MD, USA
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D. Matthew Walentiny, PhD
Department of Pharmacology & Toxicology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Patrick M. Beardsley, PhD
Department of Pharmacology & Toxicology, Virginia Commonwealth University School of Medicine, Richmond, VA, USA, Center for Biomarker Research & Precision Medicine, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA
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Abstract

Background and Purpose: The opioid epidemic remains one of the most pressing public health crises facing the United States. Rising rates of opioid-involved overdose deaths are presently driven primarily by fentanyl and related synthetic opioid agonists that are resistant to reversal by naloxone and increasingly used as adulterants or clandestine substitutes in illicitly produced opioids, sedatives, and psychostimulants. Deaths involving opioids typically result from lethal respiratory depression and it is currently unknown whether co-use of psychostimulants with opioids affects respiratory toxicity. Considering psychostimulant overdoses have increased over 3-fold since 2013, and half of those co-involved opioids, this is a cardinal question. Experimental Approach: Naloxone, d-amphetamine (AMPH), and (+/-)-methamphetamine (METH), were evaluated for their effects on basal and fentanyl-depressed respiration. Minute volume (MVb) was measured in awake, freely moving mice via whole-body plethysmography to quantify fentanyl-induced respiratory depression and its modulation by dose ranges of each test drug. Key Results: Naloxone reversed respiratory depression induced by fentanyl only at the highest dose tested (10 mg•kg-1). Both AMPH and METH exhibited bidirectional effects on MVb under basal conditions, producing depressions then elevations of respiration as dose increased. Under depressed conditions the bidirectional effects of AMPH and METH on respiration were exaggerated, exacerbating and then reversing fentanyl-induced depression as dose increased. Conclusions and Implications: These results indicate that co-use of amphetamines with fentanyl may worsen respiratory depression, but conversely, monoaminergic components of the amphetamines may possibly be exploited to mitigate fentanyl overdose.