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Eur Addict Res. 2020 Jan 15:1-6. doi: 10.1159/000505293. [Epub ahead of print]

Trauma Severity in Early Childhood Correlates with Stress and Satiety Hormone Levels in a Pilot Cohort Receiving Diamorphine Maintenance Treatment.

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Department of Psychiatry, Laboratory of Molecular Neuroscience, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany,
Department of Psychiatry, Laboratory of Molecular Neuroscience, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.
Asklepios Clinic North Ochsenzoll, Hamburg, Germany.
Institute of Clinical Chemistry, Medical School Hannover, Hannover, Germany.
Paracelsus Medical University Nuremberg, Nuremberg, Germany.
Department of Psychiatry (UPK), University of Basel, Basel, Switzerland.



Childhood trauma is of importance for the manifestation of substance-related disorders and maintenance of hypothalamic-pituitary-adrenal (HPA)-axis disorders. Since stress plays a crucial role in opioid compliance and craving, we investigated the immediate effects of diacetylmorphine application on the HPA axis. In particular, adrenocorticotropic hormone (ACTH) and cortisol secretion, as well as satiety regulating proopiomelanocortin peptides α-melanocyte-stimulating hormone (MSH) and β-endorphin (END) in a cohort of opioid-dependent patients in diamorphine maintenance treatment concerning the clinical severity of their childhood trauma.


We compared the serum levels of ACTH, cortisol, MSH, and END in 15 opioid-dependent patients. All participants received treatment with diamorphine and were observed at 5 timepoints before and after injection. We split the cohort into 2 subgroups concerning childhood trauma measured by the Childhood Trauma Questionnaire.


Splitting in 2 subgroups for mild (5) and severe trauma (10), we found that while both groups show a significant reduction of ACTH and cortisol levels over time, slopes display different progressions over time for cortisol (F[1.6] = 9.38, p = 0.02), while remaining identical for ACTH (F[1.6] = 1.69, p = 0.24). Also, levels of both MSH and END were significantly lower in severely traumatized patients.


For the first time, we present a detailed representation of stress- and addiction-related proteins for the first 5 h after diamorphine application, demonstrating the interrelationship between stress hormones and childhood trauma as well as its potential effects on the progression of addictions such as opioid dependence.


Adrenocorticotropic hormone; Cortisol; Diamorphine; Heroin; Hypothalamic-pituitary-adrenal axis; Opioid depence; Proopiomelanocortin; Stress


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