1 5035 92 PHARMACOEPIGENOMICS OF OPIATES AND METHADONE MAINTENANCE TREATMENT: CURRENT DATA AND PERSPECTIVES. CURRENT TREATMENTS OF OPIOID ADDICTION INCLUDE PRIMARILY MAINTENANCE MEDICATIONS SUCH AS METHADONE. CHRONIC EXPOSURE TO OPIATE AND/OR LONG-LASTING MAINTENANCE TREATMENT INDUCE MODULATIONS OF GENE EXPRESSION IN BRAIN AND PERIPHERAL TISSUES. THERE IS INCREASING EVIDENCE THAT EPIGENETIC MODIFICATIONS UNDERLIE THESE MODULATIONS. THIS REVIEW SUMMARIZES PUBLISHED RESULTS ON OPIOID-INDUCED EPIGENETIC CHANGES IN ANIMAL MODELS AND IN PATIENTS. THE EPIGENETIC MODIFICATIONS OBSERVED WITH OTHER DRUGS OF ABUSE OFTEN USED BY OPIATE ABUSERS ARE ALSO OUTLINED. SPECIFIC METHADONE MAINTENANCE TREATMENT INDUCED EPIGENETIC MODIFICATIONS AT DIFFERENT TREATMENT STAGES MAY BE COMBINED WITH THE ONES RESULTING FROM PATIENTS' SUBSTANCE USE HISTORY. THEREFORE, RESEARCH COMPARING GROUPS OF ADDICTS WITH SIMILAR HISTORY AND SUBSTANCES USE DISORDERS BUT CONTRASTING FOR WELL-CHARACTERIZED TREATMENT PHENOTYPES SHOULD BE ENCOURAGED. 2017 2 4847 29 OPIOID DEPENDENCE AND PREGNANCY: MINIMIZING STRESS ON THE FETAL BRAIN. INCREASE IN THE NUMBER OF OPIOID-DEPENDENT PREGNANT WOMEN DELIVERING BABIES AT RISK FOR NEONATAL ABSTINENCE SYNDROME PROMPTED A US GOVERNMENT ACCOUNTABILITY OFFICE REPORT DOCUMENTING DEFICITS IN RESEARCH AND PROVIDER KNOWLEDGE ABOUT CARE OF THE MATERNAL/FETAL UNIT AND THE NEONATE. THERE ARE 3 GENERAL SOURCES OF DEPENDENCE: UNTREATED OPIOID USE DISORDER, PAIN MANAGEMENT, AND MEDICATION-ASSISTED TREATMENT WITH METHADONE OR BUPRENORPHINE. A SURVEY OF METHADONE PATIENTS' EXPERIENCES WHEN TELLING A PHYSICIAN OF THEIR PREGNANCY AND OPIOID DEPENDENCE DEMONSTRATED PHYSICIAN CONFUSION ABOUT PROPER CARE, FREQUENT NEGATIVE INTERACTIONS WITH THE MOTHER, AND FAILURES TO PROVIDE APPROPRIATE REFERRAL. PATIENTS IN PAIN MANAGEMENT WERE DISCHARGED WITHOUT REFERRAL WHEN THE PHYSICIAN WAS TOLD OF THE PREGNANCY. METHADONE AND BUPRENORPHINE WERE FREQUENTLY SEEN NEGATIVELY BECAUSE THEY "CAUSED" NEONATAL ABSTINENCE SYNDROME. MOST MOTHERS SURVEYED HAD TO FIND OPIOID TREATMENT ON THEIR OWN. HOW DEPENDENCE IS MANAGED MEDICALLY IS A CRITICAL DETERMINANT OF THE LEVEL OF STRESS ON BOTH MOTHER AND FETUS, AND THEREFORE ANOTHER DETERMINANT OF NEONATAL HEALTH. THE EFFECTS OF BOTH OPIOID WITHDRAWAL STRESS AND MATERNAL EMOTIONAL STRESS ON NEONATAL AND DEVELOPMENTAL OUTCOMES ARE REVIEWED. CURRENTLY, THERE HAVE BEEN EFFORTS TO CRIMINALIZE MATERNAL OPIOID DEPENDENCE AND TO ENCOURAGE OR COERCE PREGNANT WOMEN TO UNDERGO WITHDRAWAL. THIS PRACTICE POSES BOTH ACUTE RISKS OF FETAL HYPOXIA AND LONG-TERM RISKS OF ADVERSE EPIGENETIC PROGRAMMING RELATED TO CATECHOLAMINE AND CORTICOSTEROID SURGES DURING WITHDRAWAL. CONTEMPORARY STUDIES OF THE EFFECTS OF WITHDRAWAL STRESS ON THE DEVELOPING FETAL BRAIN ARE URGENTLY NEEDED TO ELUCIDATE AND QUANTIFY THE RISKS OF SUCH PRACTICES. AT BIRTH, INCONSISTENCIES IN THE HOSPITAL MANAGEMENT OF NEONATES AT RISK FOR NEONATAL ABSTINENCE SYNDROME HAVE BEEN OBSERVED. NEGLECT OF THE CRITICAL ROLE OF MATERNAL COMFORTING IN NEONATAL ABSTINENCE SYNDROME MANAGEMENT IS AN IATROGENIC AND PREVENTABLE CAUSE OF POOR OUTCOMES AND LONG HOSPITALIZATIONS. ROOMING-IN ALLOWS FOR CONTINUOUS CARE OF THE BABY AND MATERNAL/NEONATAL ATTACHMENT, OFTEN UNWITTINGLY DISRUPTED BY THE NEONATAL INTENSIVE CARE UNIT ENVIRONMENT. RECOMMENDATIONS ARE MADE FOR FURTHER RESEARCH INTO PHYSICIAN/PATIENT INTERACTIONS AND INTO OPTIMAL DOSING OF METHADONE AND BUPRENORPHINE TO MINIMIZE MATERNAL/FETAL WITHDRAWAL. 2017 3 2580 26 EPIGENETICS OF MICRO-OPIOID RECEPTORS: INTERSECTION WITH HIV-1 INFECTION OF THE CENTRAL NERVOUS SYSTEM. THE ABUSE OF INTRAVENOUS DRUGS, SUCH AS HEROIN, HAS BECOME A MAJOR PUBLIC HEALTH CONCERN DUE TO THE INCREASED RISK OF HIV-1 INFECTION. OPIOIDS SUCH AS HEROIN WERE ORIGINALLY IDENTIFIED AND SUBSEQUENTLY ABUSED FOR THEIR ANALGESIC EFFECTS. HOWEVER, MANY INVESTIGATIONS HAVE FOUND ADDITIONAL EFFECTS OF OPIOIDS, INCLUDING REGULATION OF THE IMMUNE SYSTEM. AS SUCH, CHRONIC OPIOID ABUSE HAS BEEN SHOWN TO PROMOTE HIV-1 PATHOGENESIS AND FACILITATE HIV-1-ASSOCIATED NEUROCOGNITIVE DYSFUNCTION. CLINICAL OPIOIDS, SUCH AS MORPHINE AND METHADONE, AS WELL AS ILLICIT OPIOIDS, SUCH AS HEROIN, EXERT THEIR EFFECTS PRIMARILY THROUGH INTERACTIONS WITH THE MICRO-OPIOID RECEPTOR (MOR). HOWEVER, THE MECHANISMS BY WHICH OPIOIDS ENHANCE NEUROCOGNITIVE DYSFUNCTION THROUGH MOR-MEDIATED SIGNALING PATHWAYS ARE NOT COMPLETELY UNDERSTOOD. NEW FINDINGS IN THE REGULATION OF MOR EXPRESSION, PARTICULARLY EPIGENETIC AND TRANSCRIPTIONAL REGULATION AS WELL AS ALTERNATIVE SPLICING, SHEDS NEW INSIGHTS INTO POSSIBLE MECHANISMS OF HIV-1 AND OPIATE SYNERGY. IN THIS REVIEW, WE IDENTIFY MECHANISMS REGULATING MOR EXPRESSION AND PROPOSE NOVEL MECHANISMS BY WHICH OPIOIDS AND HIV-1 MAY MODULATE THIS REGULATION. ADDITIONALLY, WE SUGGEST THAT DIFFERENTIAL REGULATION OF NEWLY IDENTIFIED MOR ISOFORMS BY OPIOIDS AND HIV-1 HAS FUNCTIONAL CONSEQUENCE IN ENHANCING HIV-1 NEUROCOGNITIVE DYSFUNCTION. 2012 4 3094 36 GENOMIC AND PERSONALIZED MEDICINE APPROACHES FOR SUBSTANCE USE DISORDERS (SUDS) LOOKING AT GENOME-WIDE ASSOCIATION STUDIES. DRUG ADDICTION, OR SUBSTANCE USE DISORDER (SUD), IS A CHRONIC, RELAPSING DISORDER IN WHICH COMPULSIVE DRUG-SEEKING AND DRUG-TAKING BEHAVIOUR PERSIST DESPITE SERIOUS NEGATIVE CONSEQUENCES. DRUG ABUSE REPRESENTS A PROBLEM THAT DESERVES GREAT ATTENTION FROM A SOCIAL POINT OF VIEW, AND FOCUSES ON THE IMPORTANCE OF GENETIC STUDIES TO HELP IN UNDERSTANDING THE GENETIC BASIS OF ADDICTION AND ITS MEDICAL TREATMENT. DESPITE THE COMPLEXITY OF DRUG ADDICTION DISORDERS, AND THE HIGH NUMBER OF ENVIRONMENTAL VARIABLES PLAYING A ROLE IN THE ONSET, RECURRENCE, AND DURATION OF THE SYMPTOMS, SEVERAL STUDIES HAVE HIGHLIGHTED THE NON-NEGLIGIBLE ROLE OF GENETICS, AS DEMONSTRATED BY HERITABILITY AND GENOME-WIDE ASSOCIATION STUDIES. A CORRELATION BETWEEN THE RELATIVE RISK OF ADDICTION TO SPECIFIC SUBSTANCES AND HERITABILITY HAS BEEN RECENTLY OBSERVED, SUGGESTING THAT NEUROBIOLOGICAL MECHANISMS MAY BE, AT LEAST IN PART, INHERITED. ALL THESE OBSERVATIONS POINT TOWARDS A SCENARIO WHERE THE CORE NEUROBIOLOGICAL FACTORS OF ADDICTION, INVOLVING THE REWARD SYSTEM, IMPULSIVITY, COMPULSIVITY, STRESS, AND ANXIETY RESPONSE, ARE TRANSMITTED, AND THEREFORE, GENES AND MUTATIONS UNDERLYING THEIR VARIATION MIGHT BE DETECTED. IN THE LAST FEW YEARS, THE DEVELOPMENT OF NEW AND MORE EFFICIENT SEQUENCING TECHNOLOGIES HAS PAVED THE WAY FOR LARGE-SCALE STUDIES IN SEARCHING FOR GENETIC AND EPIGENETIC FACTORS AFFECTING DRUG ADDICTION DISORDERS AND THEIR TREATMENTS. THESE STUDIES HAVE BEEN CRUCIAL TO PINPOINT SINGLE NUCLEOTIDE POLYMORPHISMS (SNPS) IN GENES THAT AFFECT THE REACTION TO MEDICAL TREATMENTS. THIS IS CRITICALLY IMPORTANT TO IDENTIFY PHARMACOGENOMIC APPROACHES FOR SUBSTANCE USE DISORDER, SUCH AS OPRM1 SNPS AND METHADONE REQUIRED DOSES FOR MAINTENANCE TREATMENT (MMT). NEVERTHELESS, DESPITE THE PROMISING RESULTS OBTAINED BY GENOME-WIDE ASSOCIATION AND PHARMACOGENOMIC STUDIES, SPECIFIC STUDIES RELATED TO POPULATION GENETICS DIVERSITY ARE LACKING, UNDERMINING THE OVERALL APPLICABILITY OF THE PRELIMINARY FINDINGS, AND THUS POTENTIALLY AFFECTING THE PORTABILITY AND THE ACCURACY OF THE GENETIC STUDIES. IN THIS REVIEW, FOCUSING ON CANNABIS, COCAINE AND HEROIN USE, WE REPORT THE STATE-OF-THE-ART GENOMICS AND PHARMACOGENOMICS OF SUDS, AND THE POSSIBLE FUTURE PERSPECTIVES RELATED TO MEDICAL TREATMENT RESPONSE IN PEOPLE THAT ASK FOR ASSISTANCE IN SOLVING DRUG-RELATED PROBLEMS. 2021 5 976 39 CHRONIC OPIOID USE IS ASSOCIATED WITH INCREASED DNA METHYLATION CORRELATING WITH INCREASED CLINICAL PAIN. ENVIRONMENTALLY CAUSED CHANGES IN CHROMOSOMES THAT DO NOT ALTER THE DNA SEQUENCE BUT CAUSE PHENOTYPIC CHANGES BY ALTERING GENE TRANSCRIPTION ARE SUMMARIZED AS EPIGENETICS. A MAJOR EPIGENETIC MECHANISM IS METHYLATION OR DEMETHYLATION AT CPG-RICH DNA ISLANDS. DNA METHYLATION TRIGGERED BY DRUGS HAS LARGELY UNEXPLORED THERAPEUTIC CONSEQUENCES. HERE WE REPORT INCREASED METHYLATION AT A CPG RICH ISLAND IN THE OPRM1 GENE CODING FOR MU-OPIOID RECEPTORS AND AT A GLOBAL METHYLATION SITE (LINE-1) IN LEUKOCYTES OF METHADONE-SUBSTITUTED FORMER OPIATE ADDICTS COMPARED WITH MATCHED HEALTHY CONTROLS. HIGHER DNA METHYLATION ASSOCIATED WITH CHRONIC OPIOID EXPOSURE WAS REPRODUCED IN AN INDEPENDENT COHORT OF OPIOID-TREATED AS COMPARED TO NON-OPIOID-TREATED PAIN PATIENTS. THIS SUGGESTS THAT OPIOIDS MAY STIMULATE DNA METHYLATION. THE OPRM1 METHYLATION HAD NO IMMEDIATE EFFECT ON MU-OPIOID RECEPTOR TRANSCRIPTION AND WAS NOT ASSOCIATED WITH OPIOID DOSING REQUIREMENTS. HOWEVER, THE GLOBAL DNA METHYLATION AT LINE-1 WAS SIGNIFICANTLY CORRELATED WITH INCREASED CHRONIC PAIN. THIS SUGGESTS INHIBITORY EFFECTS ON THE TRANSCRIPTION OF STILL UNSPECIFIED NOCIFENSIVE GENE PRODUCTS. IT FURTHER IMPLIES THAT OPIOIDS MAY BE CAUSALLY ASSOCIATED WITH INCREASED GENOME-WIDE DNA METHYLATION, ALTHOUGH CURRENTLY THERE IS NO DIRECT EVIDENCE OF THIS. THIS HAS PHENOTYPIC CONSEQUENCES FOR PAIN AND MAY PROVIDE A NEW, EPIGENETICS-ASSOCIATED MECHANISM OF OPIOID-INDUCED HYPERALGESIA. THE RESULTS INDICATE A POTENTIAL INFLUENCE OF OPIOID ANALGESICS ON THE PATIENTS' EPIGENOME. THEY EMPHASIZE THE NEED FOR RELIABLE AND COST-EFFECTIVE SCREENING TOOLS AND MAY IMPLY THAT HIGH-THROUGHPUT SCREENING FOR LEAD COMPOUNDS IN ARTIFICIAL EXPRESSION SYSTEMS MAY NOT PROVIDE THE BEST TOOLS FOR IDENTIFYING NEW PAIN MEDICATIONS. 2013 6 1091 31 COGNITIVE ENHANCERS AS A TREATMENT FOR HEROIN RELAPSE AND ADDICTION. HEROIN ADDICTION IS A DISORDER THAT STEMS FROM MALADAPTIVE PLASTICITY WITHIN NEURAL CIRCUITS AND PRODUCES BROAD COGNITIVE DEFICITS. DESPITE CONSIDERABLE ADVANCES IN PSYCHOTHERAPY AND PHARMACOTHERAPY FOR HEROIN RELAPSE AND ADDICTION, EFFECTIVE TREATMENTS FOR HEROIN USE DISORDER ARE STILL LACKING. INCREASING PRECLINICAL EVIDENCE INDICATES THAT HEROIN SEEKING BEHAVIOR IS PERSISTENT AFTER WITHDRAWAL, WHILE COGNITIVE DYSFUNCTIONS ASSOCIATED WITH CHRONIC HEROIN USE ARE AN IMPORTANT CONTRIBUTING FACTOR TO RISK OF HEROIN RELAPSE AND ADDICTION. COGNITIVE ENHANCERS MAY BE USED TO STIMULATE TREATMENT SUCCESS AND ENHANCE TREATMENT EFFICACY. THE PURPOSE OF THIS REVIEW IS TO OUTLINE THE LITERATURE THAT DEMONSTRATES THE COGNITIVE DEFICITS DURING THE DEVELOPMENT OF HEROIN ADDICTION AND WITHDRAWAL PROCESS, AND SEVERAL FACTORS THAT UNDERLINE THE EFFICACY OF COGNITIVE ENHANCERS FOR HEROIN USE DISORDERS. THE REVIEW, THEN, EXAMINES THE POTENTIAL USE AND PHARMACOLOGICAL MECHANISMS OF COGNITIVE ENHANCERS THAT ACT ON CHOLINERGIC, GLUTAMATERGIC, DOPAMINERGIC OR ADRENERGIC PATHWAYS. IT ALSO EXAMINES THE EFFECTS OF COMPOUNDS THAT ALTER CREB SIGNALING AND EPIGENETIC MECHANISMS IN ANIMAL MODEL OF HEROIN RELAPSE. THE CURRENT BODY OF RESEARCH REVEALS THE NEW INSIGHTS INTO THE PHARMACOLOGICAL MECHANISMS UNDERLYING HEROIN ADDICTION AND HOLDS A SIGNIFICANT PROMISE FOR COGNITIVE ENHANCERS AS AN IMPROVED APPROACH TO TREAT HEROIN USE DISORDER IN A MORE EFFICIENT AND PERSISTENT WAY. 2019 7 4846 21 OPIATE ADDICTION AND COCAINE ADDICTION: UNDERLYING MOLECULAR NEUROBIOLOGY AND GENETICS. ADDICTIVE DISEASES, INCLUDING ADDICTION TO HEROIN, PRESCRIPTION OPIOIDS, OR COCAINE, POSE MASSIVE PERSONAL AND PUBLIC HEALTH COSTS. ADDICTIONS ARE CHRONIC RELAPSING DISEASES OF THE BRAIN CAUSED BY DRUG-INDUCED DIRECT EFFECTS AND PERSISTING NEUROADAPTATIONS AT THE EPIGENETIC, MRNA, NEUROPEPTIDE, NEUROTRANSMITTER, OR PROTEIN LEVELS. THESE NEUROADAPTATIONS, WHICH CAN BE SPECIFIC TO DRUG TYPE, AND THEIR RESULTANT BEHAVIORS ARE MODIFIED BY VARIOUS INTERNAL AND EXTERNAL ENVIRONMENTAL FACTORS, INCLUDING STRESS RESPONSIVITY, ADDICT MINDSET, AND SOCIAL SETTING. SPECIFIC GENE VARIANTS, INCLUDING VARIANTS ENCODING PHARMACOLOGICAL TARGET PROTEINS OR GENES MEDIATING NEUROADAPTATIONS, ALSO MODIFY VULNERABILITY AT PARTICULAR STAGES OF ADDICTION. GREATER UNDERSTANDING OF THESE INTERACTING FACTORS THROUGH LABORATORY-BASED AND TRANSLATIONAL STUDIES HAVE THE POTENTIAL TO OPTIMIZE EARLY INTERVENTIONS FOR THE THERAPY OF CHRONIC ADDICTIVE DISEASES AND TO REDUCE THE BURDEN OF RELAPSE. HERE, WE REVIEW THE MOLECULAR NEUROBIOLOGY AND GENETICS OF OPIATE ADDICTION, INCLUDING HEROIN AND PRESCRIPTION OPIOIDS, AND COCAINE ADDICTION. 2012 8 3774 26 INTERACTION OF GONADAL HORMONES, DOPAMINERGIC SYSTEM, AND EPIGENETIC REGULATION IN THE GENERATION OF SEX DIFFERENCES IN SUBSTANCE USE DISORDERS: A SYSTEMATIC REVIEW. SUBSTANCE USE DISORDER (SUD) IS A CHRONIC CONDITION CHARACTERIZED BY PATHOLOGICAL DRUG-TAKING AND SEEKING BEHAVIORS. REMARKABLY DIFFERENT BETWEEN MALES AND FEMALES, SUGGESTING THAT DRUG ADDICTION IS A SEXUALLY DIFFERENTIATED DISORDER. THE NEUROBIOLOGICAL BASES OF SEX DIFFERENCES IN SUD INCLUDE SEX-SPECIFIC REWARD SYSTEM ACTIVATION, INFLUENCED BY INTERACTIONS BETWEEN GONADAL HORMONE LEVEL CHANGES, DOPAMINERGIC REWARD CIRCUITS, AND EPIGENETIC MODIFICATIONS OF KEY REWARD SYSTEM GENES. THIS SYSTEMATIC REVIEW, ADHERING TO PICOS AND PRISMA-P 2015 GUIDELINES, HIGHLIGHTS THE SEX-DEPENDENT ROLES OF ESTROGENS, PROGESTERONE, AND TESTOSTERONE IN SUD. IN PARTICULAR, ESTRADIOL ELEVATES AND PROGESTERONE REDUCES DOPAMINERGIC ACTIVITY IN SUD FEMALES, WHILST TESTOSTERONE AND PROGESTERONE AUGMENT SUD BEHAVIOR IN MALES. FINALLY, SUD IS ASSOCIATED WITH A SEX-SPECIFIC INCREASE IN THE RATE OF OPIOID AND MONOAMINERGIC GENE METHYLATION. THE STUDY REVEALS THE NEED FOR DETAILED RESEARCH ON GONADAL HORMONE LEVELS, DOPAMINERGIC OR REWARD SYSTEM ACTIVITY, AND EPIGENETIC LANDSCAPES IN BOTH SEXES FOR EFFICIENT SUD THERAPY DEVELOPMENT. 2023 9 4937 24 PATERNAL MORPHINE EXPOSURE IN RATS REDUCES SOCIAL PLAY IN ADOLESCENT MALE PROGENY WITHOUT AFFECTING DRUG-TAKING BEHAVIOR IN JUVENILE MALES OR FEMALE OFFSPRING. THE ONGOING OPIOID ADDICTION CRISIS NECESSITATES THE IDENTIFICATION OF NOVEL RISK FACTORS TO IMPROVE PREVENTION AND TREATMENT OF OPIOID USE DISORDER. PARENTAL OPIOID EXPOSURE HAS RECENTLY EMERGED AS A POTENTIAL REGULATOR OF OFFSPRING VULNERABILITY TO OPIOID MISUSE, IN ADDITION TO HERITABLE GENETIC LIABILITY. AN UNDERSTUDIED ASPECT OF THIS "MISSING HERITABILITY" IS THE DEVELOPMENTAL PRESENTATION OF THESE CROSS-GENERATIONAL PHENOTYPES. THIS IS AN ESPECIALLY RELEVANT QUESTION IN THE CONTEXT OF INHERITED ADDICTION-RELATED PHENOTYPES, GIVEN THE PROMINENT ROLE OF DEVELOPMENTAL PROCESSES IN THE ETIOLOGY OF PSYCHIATRIC DISORDERS. PATERNAL MORPHINE SELF-ADMINISTRATION WAS PREVIOUSLY SHOWN TO ALTER THE SENSITIVITY TO THE REINFORCING AND ANTINOCICEPTIVE PROPERTIES OF OPIOIDS IN THE NEXT GENERATION. HERE, PHENOTYPING WAS EXPANDED TO INCLUDE THE ADOLESCENT PERIOD, WITH A FOCUS ON ENDOPHENOTYPES RELATED TO OPIOID USE DISORDERS AND PAIN. PATERNAL MORPHINE EXPOSURE DID NOT ALTER HEROIN OR COCAINE SELF-ADMINISTRATION IN MALE AND FEMALE JUVENILE PROGENY. FURTHER, BASELINE SENSORY REFLEXES RELATED TO PAIN WERE UNALTERED IN MORPHINE-SIRED ADOLESCENT RATS OF EITHER SEX. HOWEVER, MORPHINE-SIRED ADOLESCENT MALES EXHIBITED A REDUCTION IN SOCIAL PLAY BEHAVIOR. OUR FINDINGS SUGGEST THAT, IN MORPHINE-SIRED MALE OFFSPRING, PATERNAL OPIOID EXPOSURE DOES NOT AFFECT OPIOID INTAKE DURING ADOLESCENCE, SUGGESTING THAT THIS PHENOTYPE DOES NOT EMERGE UNTIL LATER IN LIFE. ALTERED SOCIAL BEHAVIORS IN MALE MORPHINE-SIRED ADOLESCENTS INDICATE THAT THE CHANGES IN DRUG-TAKING BEHAVIOR IN ADULTS SIRED BY MORPHINE-EXPOSED SIRES MAY BE DUE TO MORE COMPLEX FACTORS NOT YET FULLY ASSESSED. 2023 10 6617 30 UNDERPINNING THE NEUROBIOLOGICAL INTRICACIES ASSOCIATED WITH OPIOID TOLERANCE. THE OPIOID CRISIS IS A MAJOR THREAT OF THE 21ST CENTURY, WITH A REMARKABLE JUXTAPOSITION OF USE AND ABUSE. OPIOIDS ARE THE MOST POTENT AND EFFICACIOUS CLASS OF ANALGESICS, BUT DESPITE THEIR PROVEN THERAPEUTIC EFFICACY, THEY HAVE RECENTLY BEEN DEGRADED TO THIRD-LINE THERAPY FOR THE MANAGEMENT OF CHRONIC PAIN IN CLINICS. THE REASON BEHIND THIS IS THE DEVELOPMENT OF POTENTIAL SIDE EFFECTS AND TOLERANCE AFTER REPEATED DOSING. OPIOID TOLERANCE IS THE MAJOR LIMITING FACTOR LEADING TO THE WITHDRAWAL OF TREATMENT, SEVERE SIDE EFFECTS DUE TO DOSE ESCALATION, AND SOMETIMES EVEN DEATH OF THE PATIENTS. EVERY DAY MORE THAN 90 PEOPLE DIE DUE TO OPIOIDS OVERDOSE IN AMERICA, AND A SIMILAR TREND HAS BEEN SEEN ACROSS THE GLOBE. OVER THE PAST TWO DECADES, RESEARCHERS HAVE BEEN TRYING TO DISSECT THE NEUROBIOLOGICAL MECHANISM OF OPIOID TOLERANCE. RESEARCH ON OPIOID TOLERANCE SHIFTED TOWARD CENTRAL NERVOUS SYSTEM-BASED ADAPTATIONS BECAUSE TOLERANCE IS MUCH MORE THAN JUST A CELLULAR PHENOMENON. THUS, NEUROBIOLOGICAL ADAPTATIONS ASSOCIATED WITH OPIOID TOLERANCE ARE IMPORTANT TO UNDERSTAND IN ORDER TO FIND NEWER PAIN THERAPEUTICS. THESE ADAPTATIONS ARE ASSOCIATED WITH ALTERATIONS IN ASCENDING AND DESCENDING PAIN PATHWAYS, REWARD CIRCUITRY MODULATIONS, RECEPTOR DESENSITIZATION AND DOWN-REGULATION, RECEPTOR INTERNALIZATION, HETERODIMERIZATION, AND ALTERED EPIGENETIC REGULATION. THE PRESENT REVIEW IS FOCUSED ON NOVEL CIRCUITRIES ASSOCIATED WITH OPIOID TOLERANCE IN DIFFERENT AREAS OF THE BRAIN, SUCH AS PERIAQUEDUCTAL GRAY, ROSTRAL VENTROMEDIAL MEDULLA, DORSAL RAPHE NUCLEUS, VENTRAL TEGMENTAL AREA, AND NUCLEUS ACCUMBENS. UNDERSTANDING THE NEUROBIOLOGICAL MODULATIONS ASSOCIATED WITH CHRONIC OPIOID EXPOSURE AND TOLERANCE WILL PAVE THE WAY FOR THE DEVELOPMENT OF NOVEL PHARMACOLOGICAL TOOLS FOR SAFER AND BETTER MANAGEMENT OF CHRONIC PAIN IN PATIENTS. 2020 11 1160 17 CONTINUING WAR ON PAIN: A PERSONALIZED APPROACH TO THE THERAPY WITH NONSTEROIDAL ANTI-INFLAMMATORY DRUGS AND OPIOIDS. SUCCESSFUL PAIN MANAGEMENT REQUIRES THE DELIVERY OF ANALGESIA WITH MINIMAL RISK OF ADVERSE DRUG REACTIONS. NONSTEROIDAL ANTI-INFLAMMATORY DRUGS AND OPIOIDS REMAIN THE MAINSTAY OF TREATMENT FOR THE MAJORITY OF PATIENTS. UNFORTUNATELY, ALMOST 50% OF ALL PATIENTS EXPERIENCE INADEQUATE PAIN RELIEF AND SERIOUS SIDE EFFECTS. ALLELIC VARIANTS IN GENES CODING FOR TARGET PROTEINS, TRANSPORTERS AND ENZYMES, WHICH GOVERN ANALGESIC DRUGS ACTION AND THEIR FATE IN THE ORGANISM, MIGHT EXPLAIN INTER-INDIVIDUAL VARIABILITY IN PAIN SEVERITY AND IN DRUG-INDUCED PAIN RELIEF AND TOXICITIES. ADDITIONALLY, IT SEEMS THAT EPIGENETIC CHANGES CONTRIBUTE TO THE HIGHLY VARIABLE RESPONSE TO PAIN TREATMENT. THEREFORE, PHARMACOGENOMIC TESTING MIGHT BE A VALUABLE TOOL FOR PERSONALIZATION OF PAIN TREATMENT, WITH A MULTIDISCIPLINARY TEAM APPROACH INVOLVED. 2019 12 6155 33 THE GENETIC EPIDEMIOLOGY OF SUBSTANCE USE DISORDER: A REVIEW. BACKGROUND: SUBSTANCE USE DISORDER (SUD) REMAINS A SIGNIFICANT PUBLIC HEALTH ISSUE. A GREATER UNDERSTANDING OF HOW GENES AND ENVIRONMENT INTERACT TO REGULATE PHENOTYPES COMPRISING SUD WILL FACILITATE DIRECTED TREATMENTS AND PREVENTION. METHODS: THE LITERATURE STUDYING THE NEUROBIOLOGICAL CORRELATES OF SUD WITH A FOCUS ON THE GENETIC AND ENVIRONMENTAL INFLUENCES UNDERLYING THESE MECHANISMS WAS REVIEWED. RESULTS FROM TWIN/FAMILY, HUMAN GENETIC ASSOCIATION, GENE-ENVIRONMENT INTERACTION, EPIGENETIC LITERATURE, PHENOME-WIDE ASSOCIATION STUDIES ARE SUMMARIZED FOR ALCOHOL, NICOTINE, CANNABINOIDS, COCAINE, AND OPIOIDS. RESULTS: THERE ARE SUBSTANTIAL GENETIC INFLUENCES ON SUD THAT ARE EXPECTED TO INFLUENCE MULTIPLE NEUROTRANSMISSION PATHWAYS, AND THESE INFLUENCES ARE PARTICULARLY IMPORTANT WITHIN THE DOPAMINERGIC SYSTEM. GENETIC INFLUENCES INVOLVED IN OTHER ASPECTS OF SUD ETIOLOGY INCLUDING DRUG PROCESSING AND METABOLISM ARE ALSO IDENTIFIED. STUDIES OF GENE-ENVIRONMENT INTERACTION EMPHASIZE THE IMPORTANCE OF ENVIRONMENTAL CONTEXT IN SUD. EPIGENETIC STUDIES INDICATE DRUG-SPECIFIC CHANGES IN GENE EXPRESSION AS WELL AS DIFFERENCES IN GENE EXPRESSION RELATED TO THE USE OF MULTIPLE SUBSTANCES. FURTHER, GENE EXPRESSION IS EXPECTED TO DIFFER BY STAGE OF SUD SUCH AS SUBSTANCE INITIATION VERSUS CHRONIC SUBSTANCE USE. WHILE A SUBSTANTIAL LITERATURE HAS DEVELOPED FOR ALCOHOL AND NICOTINE USE DISORDERS, THERE IS COMPARATIVELY LESS INFORMATION FOR OTHER COMMONLY ABUSED SUBSTANCES. CONCLUSIONS: A BETTER UNDERSTANDING OF GENETICALLY-MEDIATED MECHANISMS INVOLVED IN THE NEUROBIOLOGY OF SUD PROVIDES INCREASED OPPORTUNITY TO DEVELOP BEHAVIORAL AND BIOLOGICALLY BASED TREATMENT AND PREVENTION OF SUD. 2017 13 747 26 CANNABIS-INDUCED HYPODOPAMINERGIC ANHEDONIA AND COGNITIVE DECLINE IN HUMANS: EMBRACING PUTATIVE INDUCTION OF DOPAMINE HOMEOSTASIS. OVER YEARS, THE REGULAR USE OF CANNABIS HAS SUBSTANTIALLY INCREASED AMONG YOUNG ADULTS, AS INDICATED BY THE RISE IN CANNABIS USE DISORDER (CUD), WITH AN ESTIMATED PREVALENCE OF 8. 3% IN THE UNITED STATES. RESEARCH SHOWS THAT EXPOSURE TO CANNABIS IS ASSOCIATED WITH HYPODOPAMINERGIC ANHEDONIA (DEPRESSION), COGNITIVE DECLINE, POOR MEMORY, INATTENTION, IMPAIRED LEARNING PERFORMANCE, REDUCED DOPAMINE BRAIN RESPONSE-ASSOCIATED EMOTIONALITY, AND INCREASED ADDICTION SEVERITY IN YOUNG ADULTS. THE ADDICTION MEDICINE COMMUNITY IS INCREASING CONCERN BECAUSE OF THE HIGH CONTENT OF DELTA-9-TETRAHYDROCANNABINOL (THC) CURRENTLY FOUND IN ORAL AND VAPING CANNABIS PRODUCTS, THE COGNITIVE EFFECTS OF CANNABIS MAY BECOME MORE PRONOUNCED IN YOUNG ADULTS WHO USE THESE CANNABIS PRODUCTS. PRELIMINARY RESEARCH SUGGESTS THAT IT IS POSSIBLE TO INDUCE 'DOPAMINE HOMEOSTASIS,' THAT IS, RESTORE DOPAMINE FUNCTION WITH DOPAMINE UPREGULATION WITH THE PROPOSED COMPOUND AND NORMALIZE BEHAVIOR IN CHRONIC CANNABIS USERS WITH CANNABIS-INDUCED HYPODOPAMINERGIC ANHEDONIA (DEPRESSION) AND COGNITIVE DECLINE. THIS PSYCHOLOGICAL, NEUROBIOLOGICAL, ANATOMICAL, GENETIC, AND EPIGENETIC RESEARCH ALSO COULD PROVIDE EVIDENCE TO USE FOR THE DEVELOPMENT OF AN APPROPRIATE POLICY REGARDING THE DECRIMINALIZATION OF CANNABIS FOR RECREATIONAL USE. 2021 14 1984 32 EPIGENETIC ALTERATIONS IN PRESCRIPTION OPIOID MISUSE: NEW STRATEGIES FOR PRECISION PAIN MANAGEMENT. PRESCRIPTION OPIOIDS ARE USED FOR SOME CHRONIC PAIN CONDITIONS. HOWEVER, GENERALLY, LONG-TERM THERAPY HAS UNWANTED SIDE EFFECTS WHICH MAY TRIGGER ADDICTION, OVERDOSE, AND EVENTUALLY CAUSE DEATHS. OPIOID ADDICTION AND CHRONIC PAIN CONDITIONS HAVE BOTH BEEN ASSOCIATED WITH EVIDENCE OF GENETIC AND EPIGENETIC ALTERATIONS. DESPITE INTENSE RESEARCH INTEREST, MANY QUESTIONS ABOUT THE CONTRIBUTION OF EPIGENETIC CHANGES TO THIS TYPOLOGY OF ADDICTION VULNERABILITY AND DEVELOPMENT REMAIN UNANSWERED. THE AIM OF THIS REVIEW WAS TO SUMMARIZE THE EPIGENETIC MODIFICATIONS DETECTED IN SPECIFIC TISSUES OR BRAIN AREAS AND ASSOCIATED WITH OPIOID PRESCRIPTION AND MISUSE IN PATIENTS WHO HAVE INITIATED PRESCRIBED OPIOID MANAGEMENT FOR CHRONIC NON-CANCER PAIN. THE REVIEW CONSIDERS THE EFFECTS OF OPIOID EXPOSURE ON THE EPIGENOME IN CENTRAL AND PERIPHERAL TISSUES IN ANIMAL MODELS AND HUMAN SUBJECTS AND HIGHLIGHTS THE MECHANISMS IN WHICH OPIOID EPIGENETICS MAY BE INVOLVED. THIS WILL IMPROVE OUR CURRENT UNDERSTANDING, PROVIDE THE BASIS FOR TARGETED, PERSONALIZED PAIN MANAGEMENT, AND THUS BALANCE OPIOID RISKS AND BENEFITS IN MANAGING CHRONIC PAIN. 2021 15 4850 32 OPIOIDS AND OPIOID RECEPTORS; UNDERSTANDING PHARMACOLOGICAL MECHANISMS AS A KEY TO THERAPEUTIC ADVANCES AND MITIGATION OF THE MISUSE CRISIS. OPIOIDS ARE A MAINSTAY IN ACUTE PAIN MANAGEMENT AND PRODUCE THEIR EFFECTS AND SIDE EFFECTS (E.G., TOLERANCE, OPIOID-USE DISORDER AND IMMUNE SUPPRESSION) BY INTERACTION WITH OPIOID RECEPTORS. I WILL DISCUSS OPIOID PHARMACOLOGY IN SOME CONTROVERSIAL AREAS OF ENQUIRY OF ANAESTHETIC RELEVANCE. THE MAIN OPIOID TARGET IS THE MICRO (MU,MOP) RECEPTOR BUT OTHER MEMBERS OF THE OPIOID RECEPTOR FAMILY, DELTA (DELTA; DOP) AND KAPPA (KAPPA; KOP) OPIOID RECEPTORS ALSO PRODUCE ANALGESIC ACTIONS. THESE ARE NALOXONE-SENSITIVE. THERE IS IMPORTANT CLINICAL DEVELOPMENT RELATING TO THE NOCICEPTIN/ORPHANIN FQ (NOP) RECEPTOR, AN OPIOID RECEPTOR THAT IS NOT NALOXONE-SENSITIVE. BETTER UNDERSTANDING OF THE DRIVERS FOR OPIOID EFFECTS AND SIDE EFFECTS MAY FACILITATE SEPARATION OF SIDE EFFECTS AND PRODUCTION OF SAFER DRUGS. OPIOIDS BIND TO THE RECEPTOR ORTHOSTERIC SITE TO PRODUCE THEIR EFFECTS AND CAN ENGAGE MONOMER OR HOMO-, HETERODIMER RECEPTORS. SOME LIGANDS CAN DRIVE ONE INTRACELLULAR PATHWAY OVER ANOTHER. THIS IS THE BASIS OF BIASED AGONISM (OR FUNCTIONAL SELECTIVITY). OPIOID ACTIONS AT THE ORTHOSTERIC SITE CAN BE MODULATED ALLOSTERICALLY AND POSITIVE ALLOSTERIC MODULATORS THAT ENHANCE OPIOID ACTION ARE IN DEVELOPMENT. AS WELL AS TARGETING LIGAND-RECEPTOR INTERACTION AND TRANSDUCTION, MODULATING RECEPTOR EXPRESSION AND HENCE FUNCTION IS ALSO TRACTABLE. THERE IS EVIDENCE FOR EPIGENETIC ASSOCIATIONS WITH DIFFERENT TYPES OF PAIN AND ALSO SUBSTANCE MISUSE. AS LONG AS THE OPIOID NARRATIVE IS DEFINED BY THE 'OPIOID CRISIS' THE DRIVE TO REMOVE THEM COULD GATHER PACE. THIS WILL DENY USE WHERE THEY ARE EFFECTIVE, AND ACCESS TO MORPHINE FOR PAIN RELIEF IN LOW INCOME COUNTRIES. 2023 16 2574 28 EPIGENETICS OF DRUG ADDICTION. SUBSTANCE USE DISORDERS (SUDS) ARE CHRONIC BRAIN DISEASES CHARACTERIZED BY TRANSITIONS FROM RECREATIONAL TO COMPULSIVE DRUG USE AND ABERRANT DRUG CRAVING THAT PERSISTS FOR MONTHS TO YEARS AFTER ABSTINENCE IS ACHIEVED. THE TRANSITION TO COMPULSIVE DRUG USE IMPLIES THAT PLASTICITY IS OCCURRING, ALTERING THE PHYSIOLOGY OF THE BRAIN TO PRECIPITATE ADDICTED STATES. EPIGENETIC PHENOMENA REPRESENT A VARIED ORCHESTRA OF TRANSCRIPTIONAL TUNING MECHANISMS THAT, IN RESPONSE TO ENVIRONMENTAL STIMULI, CREATE AND MAINTAIN GENE EXPRESSION-MEDIATED PHYSIOLOGICAL OUTCOMES. THEREFORE, EPIGENETIC MECHANISMS REPRESENT A CONVERGENT REGULATORY FRAMEWORK THROUGH WHICH THE PLASTICITY REQUIRED TO ACHIEVE AN ADDICTED STATE CAN ARISE AND THEN PERSIST LONG AFTER DRUG USE HAS ENDED. IN THE FIRST SECTION, WE WILL INTRODUCE BASIC CONCEPTS IN EPIGENETICS, SUCH AS CHROMATIN ARCHITECTURE, HISTONES AND THEIR POSTTRANSLATIONAL MODIFICATIONS, DNA METHYLATION, NONCODING RNAS, AND TRANSCRIPTION FACTORS, ALONG WITH METHODS FOR THEIR INVESTIGATION. WE WILL THEN EXAMINE THE IMPLICATIONS OF THESE MECHANISMS IN SUDS, WITH A PARTICULAR FOCUS ON COCAINE-MEDIATED NEUROEPIGENETIC PLASTICITY ACROSS MULTIPLE BEHAVIORAL MODELS OF ADDICTION. 2021 17 2259 26 EPIGENETIC PRIMING IN DRUG ADDICTION. DRUG ADDICTION IS A CHRONIC RELAPSING BRAIN DISORDER THAT IS CHARACTERIZED BY COMPULSIVE DRUG SEEKING AND CONTINUED USE DESPITE NEGATIVE OUTCOMES. CURRENT PHARMACOLOGICAL THERAPIES TARGET NEURONAL RECEPTORS OR TRANSPORTERS UPON WHICH DRUGS OF ABUSE ACT INITIALLY, YET THESE TREATMENTS REMAIN INEFFECTIVE FOR MOST INDIVIDUALS AND DO NOT PREVENT DISEASE RELAPSE AFTER ABSTINENCE. DRUGS OF ABUSE, IN ADDITION TO THEIR ACUTE EFFECTS, CAUSE PERSISTENT PLASTICITY AFTER REPEATED USE, INVOLVING DYSREGULATED GENE EXPRESSION IN THE BRAIN'S REWARD REGIONS, WHICH ARE THOUGHT TO MEDIATE THE PERSISTENT BEHAVIORAL ABNORMALITIES THAT CHARACTERIZE ADDICTION. EMERGING EVIDENCE IMPLICATES EPIGENETIC PRIMING AS A KEY MECHANISM THAT UNDERLIES THE LONG-LASTING ALTERATIONS IN NEURONAL GENE REGULATION, WHICH CAN REMAIN LATENT UNTIL TRIGGERED BY RE-EXPOSURE TO DRUG-ASSOCIATED STIMULI OR THE DRUG ITSELF. THUS, TO EFFECTIVELY TREAT DRUG ADDICTION, WE MUST IDENTIFY THE PRECISE EPIGENETIC MECHANISMS THAT ESTABLISH AND PRESERVE THE DRUG-INDUCED PATHOLOGY OF THE BRAIN REWARD CIRCUITRY. 2018 18 2934 24 GENETIC ADDICTION RISK SCORE (GARS) , A PREDICTOR OF VULNERABILITY TO OPIOID DEPENDENCE. THE INTERACTION OF NEUROTRANSMITTERS AND GENES THAT CONTROL THE RELEASE OF DOPAMINE IS THE BRAIN REWARD CASCADE (BRC). VARIATIONS WITHIN THE BRC, WHETHER GENETIC OR EPIGENETIC, MAY PREDISPOSE INDIVIDUALS TO ADDICTIVE BEHAVIORS AND ALTERED PAIN TOLERANCE. THIS DISCUSSION AUTHORED BY A GROUP OF CONCERNED SCIENTISTS AND CLINICIANS EXAMINES THE GENETIC ADDICTION RISK SCORE (GARS), THE FIRST TEST TO ACCURATELY PREDICT VULNERABILITY TO PAIN, ADDICTION, AND OTHER COMPULSIVE BEHAVIORS, DEFINED AS REWARD DEFICIENCY SYNDROME (RDS). INNOVATIVE STRATEGIES TO COMBAT EPIDEMIC OPIOID, IATROGENIC PRESCRIPTION DRUG ABUSE AND DEATH, BASED ON THE ROLE OF DOPAMINERGIC TONE IN PAIN PATHWAYS, ARE PROPOSED. SENSITIVITY TO PAIN MAY RESIDE IN THE MESOLIMBIC PROJECTION SYSTEM, WHERE GENETIC POLYMORPHISMS ASSOCIATE WITH A PREDISPOSITION TO PAIN VULNERABILITY OR TOLERANCE. THEY PROVIDE UNIQUE THERAPEUTIC TARGETS THAT COULD ASSIST IN THE TREATMENT OF PAIN, AND IDENTIFY RISK FOR SUBSEQUENT ADDICTION. PHARMACOGENOMIC TESTING OF CANDIDATE GENES LIKE CB1, MU RECEPTORS, AND PENK MIGHT RESULT IN PHARMACOGENOMIC, PERSONALIZED SOLUTIONS, AND IMPROVED CLINICAL OUTCOMES. GENETICALLY IDENTIFYING RISK FOR ALL RDS BEHAVIORS, ESPECIALLY IN COMPROMISED POPULATIONS, MAY BE A FRONTLINE TOOL TO ASSIST MUNICIPALITIES TO PROVIDE BETTER RESOURCE ALLOCATION. 2018 19 4532 23 MULTIMODAL ANALGESIA FOR PERIOPERATIVE MANAGEMENT OF PATIENTS PRESENTING FOR SPINAL SURGERY. MULTIMODAL, NON-OPIOID BASED ANALGESIA HAS BECOME THE CORNERSTONE OF ERAS PROTOCOLS FOR EFFECTIVE ANALGESIA AFTER SPINAL SURGERY. OPIOID SIDE EFFECTS, DEPENDENCE AND LEGISLATION RESTRICTING LONG TERM OPIOID USE HAS LED TO A RESURGENCE IN INTEREST IN OPIOID SPARING TECHNIQUES. THE INCREASING ARRAY OF MULTIMODAL OPIOID SPARING ANALGESICS AVAILABLE FOR SPINAL SURGERY TARGETING NOVEL RECEPTORS, TRANSMITTERS, AND ALTERING EPIGENETICS CAN HELP PROVIDE AN OPTIMAL PERIOPERATIVE EXPERIENCE WITH LESS OPIOID SIDE EFFECTS AND LONG-TERM DEPENDENCE. EPIGENETIC MECHANISMS OF PAIN MAY ENHANCE OR SUPPRESS GENE EXPRESSION, WITHOUT ALTERING THE GENOME ITSELF. SUCH MECHANISMS ARE COMPLEX, DYNAMIC AND RESPONSIVE TO ENVIRONMENT. ALTERATIONS THAT OCCUR CAN AFFECT THE PATHOPHYSIOLOGY OF PAIN MANAGEMENT AT A DNA LEVEL, MODIFYING PERCEIVED PAIN RELIEF. IN THIS REVIEW, WE PROVIDE A BRIEF OVERVIEW OF EPIGENETICS OF PAIN, SYSTEMIC LOCAL ANESTHETICS AND NEURAXIAL TECHNIQUES THAT CONTINUE TO REMAIN USEFUL FOR SPINAL SURGERY, NEUROPATHIC AGENTS, AS WELL AS OTHER COMMON AND LESS COMMON TARGET RECEPTORS FOR A TRULY MULTIMODAL APPROACH TO PERIOPERATIVE PAIN MANAGEMENT. 2019 20 4441 40 MOLECULAR GENETICS OF COCAINE USE DISORDERS IN HUMANS. DRUG ADDICTION, ONE OF THE MAJOR HEALTH PROBLEMS WORLDWIDE, IS CHARACTERIZED BY THE LOSS OF CONTROL IN DRUG INTAKE, CRAVING, AND WITHDRAWAL. AT THE INDIVIDUAL LEVEL, DRUGS OF ABUSE PRODUCE SERIOUS CONSEQUENCES ON HEALTH AND HAVE A NEGATIVE IMPACT ON THE FAMILY ENVIRONMENT AND ON INTERPERSONAL AND WORK RELATIONSHIPS. AT A WIDER SCALE, THEY HAVE SIGNIFICANT SOCIO-ECONOMIC AND PUBLIC HEALTH CONSEQUENCES AND THEY CAUSE DELINQUENCY AND CITIZEN INSECURITY. COCAINE, A PSYCHOSTIMULANT SUBSTANCE, IS ONE OF THE MOST USED ILLICIT DRUGS, ESPECIALLY IN AMERICA, WESTERN EUROPE, AND AUSTRALIA. COCAINE USE DISORDERS (CUD) ARE COMPLEX MULTIFACTORIAL CONDITIONS DRIVEN BY BOTH GENETIC AND ENVIRONMENTAL INFLUENCES. IMPORTANTLY, NOT ALL PEOPLE WHO USE COCAINE DEVELOP CUD, AND THIS IS DUE, AT LEAST IN PART, TO BIOLOGICAL FACTORS THAT ARE ENCODED IN THE GENOME OF INDIVIDUALS. ACUTE AND REPEATED USE OF COCAINE INDUCES EPIGENETIC AND GENE EXPRESSION CHANGES RESPONSIBLE FOR THE NEURONAL ADAPTATIONS AND THE REMODELING OF BRAIN CIRCUITS THAT LEAD TO THE TRANSITION FROM USE TO ABUSE OR DEPENDENCE. THE PURPOSE OF THIS REVIEW IS TO DELINEATE SUCH FACTORS, WHICH SHOULD EVENTUALLY HELP TO UNDERSTAND THE INTER-INDIVIDUAL VARIABILITY IN THE SUSCEPTIBILITY TO COCAINE ADDICTION. HERITABILITY ESTIMATES FOR CUD ARE HIGH AND GENETIC RISK FACTORS FOR COCAINE ADDICTION HAVE BEEN INVESTIGATED BY CANDIDATE GENE ASSOCIATION STUDIES (CGAS) AND GENOME-WIDE ASSOCIATION STUDIES (GWAS), REVIEWED HERE. ALSO, THE HIGH COMORBIDITY THAT EXISTS BETWEEN CUD AND SEVERAL OTHER PSYCHIATRIC DISORDERS IS WELL KNOWN AND INCLUDES PHENOTYPES LIKE SCHIZOPHRENIA, AGGRESSION, ANTISOCIAL OR RISK-TAKING BEHAVIORS. SUCH COMORBIDITIES ARE ASSOCIATED WITH A WORSE LIFETIME TRAJECTORY, AND HERE WE REPORT SHARED GENETIC FACTORS THAT MAY CONTRIBUTE TO THEM. GENE EXPRESSION CHANGES AND EPIGENETIC MODIFICATIONS INDUCED BY COCAINE USE AND CHRONIC ABUSE IN HUMANS ARE ADDRESSED BY REVIEWING TRANSCRIPTOMIC STUDIES PERFORMED ON NEURONAL CELLS AND ON POSTMORTEM BRAINS. WE REPORT SOME GENES WHICH EXPRESSION IS ALTERED BY COCAINE THAT ALSO BEAR GENETIC RISK VARIANTS FOR THE DISORDER. FINALLY, WE HAVE A GLANCE TO THE PHARMACOGENETICS OF CUD TREATMENTS, STILL IN EARLY STAGES. A BETTER UNDERSTANDING OF THE GENETIC UNDERPINNINGS OF CUD WILL FOSTER THE SEARCH OF EFFECTIVE TREATMENTS AND HELP TO MOVE FORWARD TO PERSONALIZED MEDICINE. 2022