Common Sleep Aids May Help Fight Drug, Alcohol Addiction: Rutgers Docs

NEW BRUNSWICK, NJ — Rutgers researchers think existing insomnia treatments may reduce or eliminate cravings for drugs and alcohol.

The drugs they are specifically looking at are orexin antagonists, commonly used to treat insomnia. These sleep aids are known as Belsomra, Quviviq and Davigo.

As orexin’s role in addiction has emerged, researchers have tested these medications as addiction treatments, mostly in lab mice. Research at Rutgers has found that low doses of one of these medications can reduce drug-seeking behavior in rats without sedating them or impairing cognitive function.

Moreover, a recent study from Johns Hopkins University showed that this medication can reduce cravings in people detoxifying from opioids.

“There’s obviously no guarantee orexin will effectively treat addiction, but our research gives us good reason for hope,” said Dr. Morgan James, a psychiatry professor at Robert Wood Johnson Medical School. “And the need for effective treatments is enormous. Overdose deaths have skyrocketed past 100,000 a year and existing treatment options have limited efficacy.”

The Rutgers team published their research in this review in the upcoming December 2022 issue Biological Psychiatry.

To understand how it works, here's a primer on what's known as the brain's orexin system:

The brain’s orexin system regulates sleep/wake states, reward systems and mood. Many addictive drugs — and yes, alcohol is an addictive drug — increase orexin production in both animal and human brains.

Under normal circumstances, many orexin-producing cells in the brain turn orexin production on and off in ways that raise and lower motivation. These cells turn on when, e.g., people face a tight deadline and need to get work done and turn off at night to enable sleep.

However, when people become addicted to opioids, cocaine, alcohol and other substances, these cells increase orexin production but no longer turn it off. They stay on constantly, producing high levels of orexin that motivates one behavior: getting another hit.

Rutgers' researchers found that blocking the orexin system, or turning it off at night so people can sleep, reverses addiction in animals.

Another study has even demonstrated that one of the three orexin-blocking sleep aids approved for insomnia treatment reduces opioid cravings in human subjects.

“There’s still much to discover about how orexin drives drug craving, but we know more than enough to justify testing orexin antagonists in clinical trials as addiction treatments,” said Gary Aston-Jones, coauthor of the review and director of the Rutgers Brain Health Institute. “We’re applying for funding from the National Institutes of Health and looking to hire a physician-scientist with clinical trial experience to lead these efforts.”

Controlled studies of mice, rats, zebrafish and other animals have allowed researchers to systematically examine each step in the process. Postmortem analysis of brain tissue from people who used heroin shows the same increase in the human orexin system that researchers have observed in addicted animals. Once triggered, this overactivity may last forever — indeed, the research team observed increased orexin levels in cocaine-addicted rats that stayed sober for more than a quarter of their natural lifespan.