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Fentanyl-Induced Brain Hypoxia Triggers Brain Hyperglycemia and Biphasic Changes in Brain Temperature.

Study Authors Eugene Kiyatkin and Ernesto Solis

Study Authors Eugene Kiyatkin and Ernesto Solis, Jr.

Featured Paper of the Month – May 2018.

Fentanyl is a potent synthetic opioid used clinically to treat pain and as a general anesthetic. Recently, fentanyl has emerged as a recreational drug and its overdose has been linked to numerous deaths in the US. To better understand how fentanyl affects the brain, we used electrochemical techniques in rats and examined the effect of intravenous fentanyl on oxygen and glucose levels in the nucleus accumbens, a brain region implicated in reward and addiction. Oxygen and glucose are metabolism-related substances that must be constantly supplied to the brain for it to function properly. We found that at doses corresponding to human consumption, fentanyl caused brain oxygen levels to drop within seconds and subsequently glucose levels to increase. By measuring oxygen in a highly-vascularized region under the skin, we determined that the fentanyl-induced brain hypoxia is caused by the drop of blood oxygen levels resulting from drug-induced breathing depression. Diminished breathing also leads to carbon dioxide accumulation, which in turn causes vasodilation of blood vessels in the brain allowing enhanced glucose entry into the brain. Compared to other opioids, such as heroin or morphine, fentanyl doses required to cause hypoxia were very low, which highlights the danger when mistakenly consuming fentanyl instead of heroin or heroin that was contaminated with fentanyl.

Publication Information

Solis, Ernesto Jr; Cameron-Burr, Keaton T; Shaham, Yavin; Kiyatkin, Eugene A

Fentanyl-Induced Brain Hypoxia Triggers Brain Hyperglycemia and Biphasic Changes in Brain Temperature. Journal Article

In: Neuropsychopharmacology, vol. 43, no. 4, pp. 810–819, 2018, ISSN: 1740-634X (Electronic); 0893-133X (Linking).

Abstract | Links

@article{Solis:2018aa,
title = {Fentanyl-Induced Brain Hypoxia Triggers Brain Hyperglycemia and Biphasic Changes in Brain Temperature.},
author = {Ernesto Jr Solis and Keaton T Cameron-Burr and Yavin Shaham and Eugene A Kiyatkin},
url = {https://www.ncbi.nlm.nih.gov/pubmed/28849778},
doi = {10.1038/npp.2017.181},
issn = {1740-634X (Electronic); 0893-133X (Linking)},
year = {2018},
date = {2018-03-01},
urldate = {2018-03-01},
journal = {Neuropsychopharmacology},
volume = {43},
number = {4},
pages = {810--819},
address = {Behavioral Neuroscience Branch, National Institute on Drug Abuse-Intramural Research Program, National Institutes of Health, DHHS, Baltimore, MD, USA.},
abstract = {Fentanyl is a potent synthetic opioid used extensively in humans for general anesthesia and analgesia. Fentanyl has emerged as a recreational drug, often in combination with heroin, and can result in lethality during overdose. Fentanyl is well characterized as an anesthetic, but the basic physiological effects of fentanyl in the brain when taken as a drug of abuse are largely unknown. We used high-speed amperometry in freely moving rats to examine the effects of intravenous fentanyl at doses within the range of possible human intake (3-40 mug/kg) on oxygen and glucose levels in nucleus accumbens (NAc). Fentanyl induced a rapid, dose-dependent decrease in NAc oxygen followed by a more delayed and prolonged increase in NAc glucose. Fentanyl induced similar oxygen decreases in the basolateral amygdala, indicating that brain hypoxia could be a generalized phenomenon. We used oxygen recordings in the subcutaneous space to confirm that fentanyl-induced brain hypoxia results from decreases in blood oxygen levels caused by drug-induced respiratory depression. Temperature recordings in the NAc, muscle, and skin showed that fentanyl induces biphasic changes in brain temperature, with an initial decrease that results primarily from peripheral vasodilation, and a subsequent increase driven by metabolic brain activation. The initial vasodilation appears caused by respiratory depression-induced hypoxia and a subsequent rise in CO2 that drives fentanyl-induced increases in NAc glucose. Together, these data suggest that fentanyl-induced respiratory depression triggers brain hypoxia and subsequent hyperglycemia, both of which precede slower changes in brain temperature and metabolic brain activity.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

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Fentanyl is a potent synthetic opioid used extensively in humans for general anesthesia and analgesia. Fentanyl has emerged as a recreational drug, often in combination with heroin, and can result in lethality during overdose. Fentanyl is well characterized as an anesthetic, but the basic physiological effects of fentanyl in the brain when taken as a drug of abuse are largely unknown. We used high-speed amperometry in freely moving rats to examine the effects of intravenous fentanyl at doses within the range of possible human intake (3-40 mug/kg) on oxygen and glucose levels in nucleus accumbens (NAc). Fentanyl induced a rapid, dose-dependent decrease in NAc oxygen followed by a more delayed and prolonged increase in NAc glucose. Fentanyl induced similar oxygen decreases in the basolateral amygdala, indicating that brain hypoxia could be a generalized phenomenon. We used oxygen recordings in the subcutaneous space to confirm that fentanyl-induced brain hypoxia results from decreases in blood oxygen levels caused by drug-induced respiratory depression. Temperature recordings in the NAc, muscle, and skin showed that fentanyl induces biphasic changes in brain temperature, with an initial decrease that results primarily from peripheral vasodilation, and a subsequent increase driven by metabolic brain activation. The initial vasodilation appears caused by respiratory depression-induced hypoxia and a subsequent rise in CO2 that drives fentanyl-induced increases in NAc glucose. Together, these data suggest that fentanyl-induced respiratory depression triggers brain hypoxia and subsequent hyperglycemia, both of which precede slower changes in brain temperature and metabolic brain activity.

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  • https://www.ncbi.nlm.nih.gov/pubmed/28849778
  • doi:10.1038/npp.2017.181

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