Tuesday, April 4, 2006

Naltrexone can induce opioid-withdrawal in heavy tanners

Ok, so this is off topic but I cannot stop thinking about this paper, and it does involve opioid antagonists,** so I'm filing this under "suggestive new evidence regarding endogenous opioid physiology."

I have long been suspicious that tanning has addictive qualities, or at least involved some psychopathology.  Actually I always thought it was a form of body dysmorphic disorder--I assumed there must be some reason my wrinkled, baked-brown-leather acquaintances and patients kept on going back to the tanning booth.  I'm not talking about the casual users who keep their tans going over winter in the Midwest for instance, but those UV ravaged, burnt orange hued, deeply creviced people that you can't imagine get up in the morning, look in the mirror, and say "Back to the booth today!"  Perhaps this is small-minded of me, but I always assumed something was wrong.

Well, the Journal of the American Academy of Dermatology has fired an initial salvo, with an article demonstrating opioid-withdrawal syndromes in chronic, heavy tanners.  The story goes like this:  UV radiation induces cutaneous endogenous opioid production & clearly some dermatologists have noticed that some people tan more than seems necessary to maintain a 'healthy' tanned appearance.  The researchers took 8 heavy tanners (8-15 times a month!) and 8 light tanners and randomized them to UV or non-UV tanning beds, as well as gave them escalating doses of naltrexone.  Essentially they found that 1) heavy tanners preferred the UV beds even when blinded to the fact they were UV, 2) naltrexone blunted the heavy tanners' preference to the UV beds, and 3) half the heavy tanners had an opioid-withdrawal-like syndrome with naltrexone.  Of course the numbers are small, and the researches may have happened to stumble upon a nest of "Oxy" abusing tanners inadvertantly, but this is pretty damn interesting and personally satisfying nevertheless.  I can already imagine the implications of this including UV booths in hospices (ha ha). 

I read this on Medscape today, then looked around to see if it is being picked up by other news outlets, and indeed it is.  And, predictably, its findings are already being misconstrued including the headline " You can get hooked on tanning because it gets you high, study says ."

**It sort of reminds me of the reports of opioid-withdrawal syndromes in opioid naive patients given opioid antagonists for cholestatic pruritis (suggesting that endogenous opioid levels are substantially elevated in cirrhosis/cholestasis & responsible for the pruritis).

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