La variabilité interindividuelle dans la réponse aux médicaments constitue une problématique importante pouvant causer des effets indésirables ou l’échec d’un traitement. Ces variabilités peuvent être causées par une diminution de l’activité de l’enzyme responsable du métabolisme de certains médicaments, fréquemment les cytochromes P450, un système enzymatique majeur dans le métabolisme de ces derniers. Ces enzymes sont sujets à des mutations génétiques appelées polymorphismes, qui altèrent l’activité métabolique. Il est donc important d’évaluer le rôle de ces enzymes dans le métabolisme des médicaments afin d’identifier leur responsabilité dans la variabilité interindividuelle de la réponse au traitement. Parmi l’important système enzymatique que représentent les cytochromes P450, l’isoenzyme CYP2D6 est particulièrement étudiée, ses variations métaboliques revêtant une haute importance clinique. L’un des substrats du CYP2D6 est l’oxycodone, un analgésique narcotique largement prescrit en clinique. Une grande variabilité est observée dans la réponse analgésique à l’oxycodone, variabilité pouvant être causée par un polymorphisme génétique. Il est connu que des variations génétiques dans le CYP2D6 compromettent la réponse analgésique à la codéine en rendant moins importante la formation de son métabolite actif, la morphine. Par analogie, plusieurs études supportent l’hypothèse selon laquelle le métabolite oxymorphone, formée par l’isoenzyme CYP2D6, serait responsable de l’analgésie de l’oxycodone. Une déficience génétique de l’enzyme compromettrait la réponse analgésique au médicament. Les travaux effectués dans le cadre de ce mémoire ont démontré que l’inhibition du CYP2D6 chez des sujets volontaires réduit de moitié la production d’oxymorphone, confirmant l’importante implication de l’enzyme dans le métabolisme de l’oxycodone. Ces résultats démontrent une forte ressemblance avec le métabolisme de la codéine, suggérant que l’oxymorphone pourrait être responsable de l’analgésie. Cependant, les travaux effectués n’ont pu établir de relation entre la concentration plasmatique d’oxymorphone et le niveau d’analgésie ressenti par les sujets. La continuation des études sur le mécanisme d’action de l’oxycodone dans la réponse analgésique est essentielle afin d’établir la source des variabilités interindividuelles expérimentées par les patients et ainsi d’éviter des effets secondaires ou lacunes dans le traitement. / Intersubject variability in drug response is an important issue provoking side effects or treatment failure. Such variability may be caused by the decreased activity of the enzyme metabolising the drug, frequently cytochromes P450, a major enzyme system in drug metabolism. These enzymes are prone to genetic mutations called polymorphisms, which alter their metabolic activity. It is therefore important to assess the role of these enzymes to identify their responsibility in the intersubject variability of the drug. Among the important enzyme system that represents the cytochrome P450, CYP2D6 is particularly studied for its genetic polymorphisms, which are of clinical importance. One of CYP2D6 substrates is oxycodone, a narcotic analgesic widely prescribed in clinical practice. A large variability is observed in the analgesic response to oxycodone, which could be caused by genetic polymorphism. It is known that these variations affect the analgesic response to codeine, which form the active metabolite morphine by CYP2D6 to be effective. Several studies support the hypothesis that oxymorphone, a metabolite formed by CYP2D6, has the analgesia properties, in a similar mechanism to codeine. A genetic deficiency in the enzyme would compromise the analgesic response to the drug. Results obtained from our laboratory indicate that inhibition of CYP2D6 halved oxymorphone production, confirming the significant involvement of the enzyme in the metabolism of oxycodone. These results demonstrate a strong resemblance to codeine metabolism, suggesting that oxymorphone may be responsible for analgesia. We could not find a relationship between plasma concentration of oxymorphone and analgesia level experienced by subjects. Studies on oxycodone mecanism of action in the analgesic response should continue to establish the source of intersubject variability experienced by patients and thus avoid side effects or gaps in treatment.

Despite decades of research on amphetamine derivatives, a class of compounds sharing a structural foundation with amphetamine, crucial gaps remain in our understanding of these drugs in a variety of animal species and humans. This dissertation addresses three of these gaps through a multi-level approach involving studies in both humans and mice. Specifically, it focuses on investigating the lack of information regarding: 1) repeated dosing of 3,4-methylenedioxymethamphetamine in humans, 2) methamphetamine/alcohol combinations in humans and 3) methamphetamine/oxycodone combinations in mice. Study 1 involved administering three consecutive doses of 3,4 methylenedioxymethamphetamine to human volunteers at 12- and 24-hour intervals while physiological, behavioral, and subjective measures were collected. Study 2 reanalyzed Kirkpatrick and colleagues (2012a) data to evaluate repeated administrations of methamphetamine and alcohol. The reanalysis focused on quantifying the physiological and subjective effect differences between the first and second administrations, which occurred at a 12-hour interval on the same day, an aspect not previously analyzed or reported by the original authors. Study 3 utilized well-established animal models such as Conditioned Place Preference, Open Field Test, and Novel Object Recognition to evaluate the reward-like and aversive effects of methamphetamine and oxycodone combinations in mice. Study 1 was the first to quantify the effects of multiple 3,4-methylenedioxymethamphetamine doses administered over a 36-hour period of time. Initially, acute 3,4-methylenedioxymethamphetamine produced dose-dependent increases in peak heart rate, blood pressure, and more positive than negative subjective effects. However, by the third dose, many of these effects dissipated, heart rate was no longer elevated, and residual mood effects were minor. Overall, the data do not support the general perception that 3,4-methylenedioxymethamphetamine produces dangerous cardiovascular and residual mood effects in humans following repeated administration. The results of Study 2, again a first in the field, discovered that contrary to expectations, heart rate increases produced by the methamphetamine/alcohol combination were not further increased with repeated dosing, but rather attenuated. In fact, methamphetamine offset alcohol-induced intoxication, even after repeated administration. Study 3 revealed that combining methamphetamine and oxycodone in mice increased reward as measured by Conditioned Place Preference, but not more than either drug alone. However, methamphetamine lengthened the duration of Conditioned Place Preference for the lower oxycodone dose and offset the oxycodone-induced disruptions in novel object recognition performance. One crucial cross-species observation was that methamphetamine mitigated adverse effects such as alcohol-related intoxication and oxycodone cognitive disruption, even after repeated administration. While seemingly beneficial, this observation raises concerns that individuals who combine these drugs may be at risk of underestimating their overall degree of impairment, potentially leading to hazardous activities like driving while intoxicated or engaging in risky behaviors. Sharing this insight is crucial to encourage informed, responsible behavior and safeguard public safety. In conclusion, these studies have significantly enhanced our understanding of two frequently used amphetamine derivatives and their interactions with two commonly used psychoactive drugs—oxycodone and alcohol. Most importantly, we strongly advocate for robust empirical experimentation to counteract misinformation related to 3,4-methylenedioxymethamphetamine and methamphetamine. These endeavors are crucial for developing more precise assessments of the risks and benefits associated with these substances, and for improving drug policies and optimizing public health interventions.