β-arrestins: regulatory role and therapeutic potential in opioid and cannabinoid receptor-mediated analgesia
Open accessAbstract
Pain is a complex disorder with neurochemical and psychological components contributing to the severity, the persistence, and the difficulty in adequately treating the condition. Opioid and cannabinoids are two classes of analgesics that have been used to treat pain for centuries and are arguably the oldest of "pharmacological" interventions used by man. Unfortunately, they also produce several adverse side effects that can complicate pain management. Opioids and cannabinoids act at G protein-coupled receptors (GPCRs), and much of their effects are mediated by the mu-opioid receptor (MOR) and cannabinoid CB1 receptor (CB1R), respectively. These receptors couple to intracellular second messengers and regulatory proteins to impart their biological effects. In this chapter, we review the role of the intracellular regulatory proteins, β-arrestins, in modulating MOR and CB1R and how they influence the analgesic and side-effect profiles of opioid and cannabinoid drugs in vivo. This review of the literature suggests that the development of opioid and cannabinoid agonists that bias MOR and CB1R toward G protein signaling cascades and away from β-arrestin interactions may provide a novel mechanism by which to produce analgesia with less severe adverse effects.
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Mutant mice lacking arrestin 3 exhibited greater analgesia but significantly less antinociceptive tolerance, physical dependence, constipation, and respiratory suppression in response to morphine.
“Mutant mice that lacked arrestin 3 (b-arrestin 2) exhibited greater analgesia but significantly less antinociceptive tolerance, physical dependence, constipation, and respiratory suppression in response to morphine (Raehal and Bohn, 2014).”
From Drug Addiction: Hyperkatifeia/Negative Reinforcement as a Framework for Medications Development (2021) · cites this paper as Raehal and Bohn, 2014
Section 7 states that mice lacking β-arrestin2 have enhanced morphine analgesia and less antinociceptive tolerance, physical dependence, constipation, and respiratory suppression. It qualifies the dependence finding: dependence is reduced at lower morphine doses, but at high doses it is indistinguishable from that in wild-type mice. The claim omits that dose limitation. (LLM, conf=0.87)
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The CB1 Receptor as the Cornerstone of Exostasis
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CGRP receptor antagonist activity of olcegepant depends on the signalling pathway measured
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Current and Future Issues in the Development of Spinal Agents for the Management of Pain
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Assessment of Biased Agonism among Distinct Synthetic Cannabinoid Receptor Agonist Scaffolds
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Site and mechanism of morphine tolerance in the gastrointestinal tract
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Clinical Pharmacology, Toxicity, and Abuse Potential of Opioids
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Update on the Pharmacology and Legal Status of Kratom
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Pharmacologic and clinical assessment of kratom: An update
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Arresting the Development of Addiction: The Role of β-Arrestin 2 in Drug Abuse
Porter‐Stransky, K. A., & Weinshenker, D. (2017) · Journal of Pharmacology and Experimental Therapeutics · doi:10.1124/jpet.117.240622 · Cited by 43 · see citing works
The American Psychiatric Association Publishing Textbook of Substance Use Disorder Treatment
Brady, K. T., LEVIN, F. R., Galanter, M. S., & Kleber, H. D. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615373970 · Cited by 41 · see citing works
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Analysis of natural product regulation of opioid receptors in the treatment of human disease
Badal, S. A. M., Turfus, S. C., Rajnarayanan, R. V., Wilson-Clarke, C. F., & Sandiford, S. L. (2017) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2017.10.021 · Cited by 36 · see citing works
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Emerging Insights into Mu Opioid Pharmacology
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The Basic Science of Cannabinoids
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Chapter 13. Methadone and Buprenorphine Maintenance Treatment of Opioid-Related Disorders
Strain, E. C., & Stoller, K. B. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615373970.kb13 · Cited by 27 · see citing works
Optimizing Perioperative Use of Opioids: a Multimodal Approach
Ramirez, M. F., Kamdar, B. B., & Cata, J. P. (2020) · Current anesthesiology reports · doi:10.1007/s40140-020-00413-6 · Cited by 28 · see citing works
Yang, Y., Wang, Y., Zuo, A., Li, C., Wang, W., Jiang, W., Zhang, X., Che, X., Zhang, Y., Wu, W., et al. (2021) · European Journal of Medicinal Chemistry · doi:10.1016/j.ejmech.2021.113986 · Cited by 27 · see citing works
Chapter 2. Genetics and Epigenetics of Addiction
Gelernter, J. E., & Polimanti, R. A. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615373970.kb02 · Cited by 26 · see citing works
Chapter 37. Substance-Related Disorders in Adolescents
Roten, A. T., & Gray, K. M. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615373970.kb37 · Cited by 26 · see citing works
Chapter 3. Epidemiology of Addiction
Smith, N., & Cottler, L. B. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615373970.kb03 · Cited by 26 · see citing works
Type‐1 cannabinoid receptors and their ever‐expanding roles in brain energy processes
Fernández‐Moncada, I., Rodrigues, R. S., Fundazuri, U. B., Bellocchio, L., & Marsicano, G. (2023) · Journal of Neurochemistry · doi:10.1111/jnc.15922 · Cited by 26 · see citing works
Analysis of natural product regulation of cannabinoid receptors in the treatment of human disease
Badal, S. A. M., Smith, K. N., & Rajnarayanan, R. V. (2017) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2017.06.003 · Cited by 26 · see citing works
Chapter 48. Trauma- and Stressor-Related Disorders
Fitzpatrick, S., Jarnecke, A. M., Back, S. E., Straus, E., Norman, S., & Hien, D. A. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615373970.kb48 · Cited by 25 · see citing works
Holloman, B. L., Nagarkatti, M., & Nagarkatti, P. S. (2021) · International Journal of Molecular Sciences · doi:10.3390/ijms22147302 · Cited by 27 · see citing works
Weinberg, Z. Y., Zajac, A. S., Phan, T., Shiwarski, D., & Puthenveedu, M. (2017) · Molecular Pharmacology · doi:10.1124/mol.116.106633 · Cited by 27 · see citing works
Chapter 35. Prevention of Substance Use Disorders
Champion, K. E., Newton, N. C., & Teesson, M. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615373970.kb35 · Cited by 24 · see citing works
Chapter 23. Cognitive-Behavioral Therapy
Carroll, K. M., & Kiluk, B. D. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615373970.kb23 · Cited by 23 · see citing works
Steinglass, P. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615373970.kb27 · Cited by 23 · see citing works
Chapter 25. Motivational Enhancement
Shulman, M., Pruzan, K., & Carpenter, K. M. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615373970.kb25 · Cited by 23 · see citing works
Wai, J. M., Shulman, M., & Nunes, E. V. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615373970.kb44 · Cited by 23 · see citing works
Banister, S. D., Kumar, K. K., Kumar, V., Kobilka, B. K., & Malhotra, S. V. (2019) · MedChemComm · doi:10.1039/c8md00595h · Cited by 22 · see citing works
Oliceridine- Opioid of the 21st Century
Goudra, B. (2022) · Saudi Journal of Anaesthesia · doi:10.4103/sja.sja_510_21 · Cited by 23 · see citing works
Kratom Dependence and Treatment Options: A Comprehensive Review of the Literature
Abdullah, M. F. I. L. B. (2020) · Current Drug Targets · doi:10.2174/1389450121666200719011653 · Cited by 22 · see citing works
Swingler, M., Donadoni, M., Unterwald, E. M., Maggirwar, S. B., & Sariyer, I. K. (2025) · Frontiers in Neuroscience · doi:10.3389/fnins.2025.1597922 · Cited by 21 · see citing works
Class A and C GPCR Dimers in Neurodegenerative Diseases
Moreira, I. S., Caniceiro, A. B., Bueschbell, B., & Schiedel, A. C. (2022) · Current Neuropharmacology · doi:10.2174/1570159x20666220327221830 · Cited by 18 · see citing works
Respiratory effects of low and high doses of fentanyl in control and β-arrestin 2-deficient mice
Haouzi, P. A., McCann, M. L., & Tubbs, N. (2021) · Journal of Neurophysiology · doi:10.1152/jn.00711.2020 · Cited by 20 · see citing works
Oliceridine and its potential to revolutionize GI endoscopy sedation
Goudra, B., & Singh, P. M. (2020) · Saudi Journal of Anaesthesia · doi:10.4103/sja.sja_813_19 · Cited by 19 · see citing works
Evidence for the emergence of an opioid‐resistant respiratory rhythm following fentanyl overdose
Haouzi, P. A., Mellen, N. M., McCann, M. L., Sternick, M. E., Guck, D., & Tubbs, N. (2020) · Respiratory Physiology & Neurobiology · doi:10.1016/j.resp.2020.103428 · Cited by 19 · see citing works
Iannotti, F. A., & Marzo, V. D. (2025) · Pharmacological Reviews · doi:10.1016/j.pharmr.2025.100070 · Cited by 21 · see citing works
Zhang, Y., Williams, D. A., Zaidi, S. A., Yuan, Y., Braithwaite, A., Bilsky, E. J., Dewey, W. L., Akbarali, H. I., Streicher, J. M., & Selley, D. E. (2015) · ACS Chemical Neuroscience · doi:10.1021/acschemneuro.5b00245 · Cited by 18 · see citing works
Goudra, B., Singh, P., & Lichtenstein, G. (2020) · Digestive Diseases and Sciences · doi:10.1007/s10620-020-06464-3 · Cited by 16 · see citing works
Fipps, D. C., Oesterle, T., & Kolla, B. P. (2024) · Seminars in Neurology · doi:10.1055/s-0044-1787571 · Cited by 16 · see citing works
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New Insights Into Peptide Cannabinoids: Structure, Biosynthesis and Signaling
Riquelme-Sandoval, A., de Sá-Ferreira, C. O., Miyakoshi, L. M., & Hedin‐Pereira, C. (2020) · Frontiers in Pharmacology · doi:10.3389/fphar.2020.596572 · Cited by 13 · see citing works
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Opioids and Vitamin C: Known Interactions and Potential for Redox-Signaling Crosstalk
Newman, M. S., Connery, H., & Boyd, J. (2022) · Antioxidants · doi:10.3390/antiox11071267 · Cited by 12 · see citing works
Bedini, A., Cuna, E., Baiula, M., & Spampinato, S. M. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23095114 · Cited by 10 · see citing works
Kratom use disorder: a primer for primary care physicians
Groff, D., Stuckey, H. L., Philpott, C. D., Dyke, E. V., Silvis, M. L., Leong, S. L., & Bone, C. (2021) · Journal of Addictive Diseases · doi:10.1080/10550887.2021.1950263 · Cited by 10 · see citing works
The Development of Cannabinoids as Therapeutic Agents in the United States
Murray, C. H., Gannon, B. M., Winsauer, P. J., Cooper, Z. D., & Delatte, M. S. (2024) · Pharmacological Reviews · doi:10.1124/pharmrev.123.001121 · Cited by 9 · see citing works
Opioid Modulation of Neuronal Iron and Potential Contributions to NeuroHIV
Nash, B., Irollo, E., Brandimarti, R., & Meucci, O. (2020) · Methods in molecular biology · doi:10.1007/978-1-0716-0884-5_13 · Cited by 8 · see citing works
Jeong, B., Song, Y. P., Chung, J. Y., Park, K. C., Kim, J., So, I., & Hong, C. (2023) · American Journal of Physiology-Cell Physiology · doi:10.1152/ajpcell.00535.2022 · Cited by 7 · see citing works
Sheikh, S., Fernandez, R., Smotherman, C. R., Brailsford, J., Langaee, T. Y., Velasquez, E., Henson, M., Munson, T., Bertrand, A. H., Hendry, P. L., et al. (2023) · Clinical and Translational Science · doi:10.1111/cts.13634 · Cited by 7 · see citing works
Pearl‐Dowler, L., Posa, L., López-Canul, M., Teggin, A., & Gobbi, G. (2023) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2023.110805 · Cited by 7 · see citing works
Sharma, A., Dunn, K. E., Schmid-Doyle, K., Dowell, S., Kim, N., Strain, E. C., & Bergeria, C. L. (2024) · Journal of Addiction Medicine · doi:10.1097/adm.0000000000001395 · Cited by 6 · see citing works
Ford, B. M., Cabanlong, C. V., Tai, S., Franks, L. N., Penthala, N. R., Crooks, P. A., Prather, P. L., & Fantegrossi, W. E. (2019) · Journal of Pharmacology and Experimental Therapeutics · doi:10.1124/jpet.118.252965 · Cited by 6 · see citing works
Huang, Y., Lu, S., Chen, Y., Feng, Y., & Lu, W. (2023) · Naunyn-Schmiedeberg s Archives of Pharmacology · doi:10.1007/s00210-023-02697-x · Cited by 5 · see citing works
Chapter 47. Attention-Deficit/Hyperactivity Disorder
Wilens, T. E., & Kaminski, T. A. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615373970.kb47 · Cited by 5 · see citing works
Larauche, M. H., Érchegyi, J., Miller, C. L., Sim, M., Rivier, J., Behan, D. P., & Taché, Y. (2022) · Peptides · doi:10.1016/j.peptides.2022.170881 · Cited by 4 · see citing works
Rational design of Gi-biased CB1 agonist with reduced side effects
Liao, Y.-Y., Che, J., Yun-tao, G., Xue, J., Li, L., Wu, L.-L., Hu, J.-X., Hu, M.-T., Xie, L., Zhang, H., et al. (2026) · Cell · doi:10.1016/j.cell.2026.03.020 · Cited by 3 · see citing works
Gajic, P., Kovac, I., Lubinsky, G. T., & Knežević, N. N. (2026) · Cells · doi:10.3390/cells15100858 · Cited by 3 · see citing works
Chapter 20. Neurobiology and Treatment of Sedative-, Hypnotic-, and Anxiolytic-Related Disorders
Jones, J. L., VandenBerg, A., & Malcolm, R. J. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615373970.kb20 · Cited by 3 · see citing works
Chapter 10. Neurobiology of Stimulants
Sofuoglu, M., DeVito, E. E., & Kosten, T. R. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615373970.kb10 · Cited by 3 · see citing works
Chapter 14. Opioid Antagonist Treatment of Opioid-Related Disorders
Capata, M., & Hartwell, K. J. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615373970.kb14 · Cited by 3 · see citing works
Perioperative Pain, Analgesics and Cancer-Related Outcomes: where do we Stand?
Ramirez, M. F., Rangel, F. P., & Cata, J. P. (2021) · Pain Management · doi:10.2217/pmt-2021-0070 · Cited by 3 · see citing works
Chapter 34. Nicotine and Public Health
Cummings, K. M., Borland, R., & Braak, D. C. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615373970.kb34 · Cited by 3 · see citing works
Dezocine and Addiction: Friend or Foe?
Childers, W. E., Elokely, K. M., & Abou-Gharbia, M. A. (2025) · Pharmaceuticals · doi:10.3390/ph18030386 · Cited by 2 · see citing works
Chapter 4. Substance Use Disorder Diagnoses in DSM-5
Hasin, D. S., & Larson, F. R. R. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615373970.kb04 · Cited by 2 · see citing works
Zangrandi, L., Fogli, B., Mutti, A., Staritzbichler, R., Most, V., Hildebrand, P. W., Heilbronn, R., & Schwarzer, C. (2024) · Frontiers in Pharmacology · doi:10.3389/fphar.2024.1484730 · Cited by 2 · see citing works
Wattiez, A., Walder, R. Y., Sande, C. M., White, S. R., & Hammond, D. L. (2017) · Molecular Pain · doi:10.1177/1744806917715210 · Cited by 2 · see citing works
Koob, G. F., Arends, M. A., McCracken, M. L., & Moal, M. L. (2023) · Elsevier eBooks · doi:10.1016/b978-0-12-816988-9.00001-1 · Cited by 2 · see citing works
Chapter 49. Schizophrenia Spectrum and Other Psychotic Disorders
Schwartz, E., Brunette, M. F., & Green, A. I. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615373970.kb49 · Cited by 2 · see citing works
Chapter 18. Neurobiology of Nicotine and Tobacco
Gubner, N. R., & Benowitz, N. L. (2021) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615373970.kb18 · Cited by 2 · see citing works
- Authors
- Raehal, K. M., & Bohn, L. M.
- Affiliations
- Scripps Research Institute (US)
- Corresponding author
- Raehal, Kirsten M.
- ORCID
- Bohn, Laura M.
- Venue
- Handbook of Experimental Pharmacology
- Publisher
- Springer Berlin Heidelberg
- Published
- 2013-11-05
- Volume
- 219
- Pages
- 427-443
- ISSN
- 0171-2004 (ISSN-L)
- 1865-0325
- PMC
- PMC4804701
- OpenAlex
- W78722479
- Cited by
- 154
- References
- 99
- Citations by year
- 2026: 3 · 2025: 10 · 2024: 5 · 2023: 7 · 2022: 10 · 2021: 63 · 2020: 13 · 2019: 11 · 2018: 7 · 2017: 15 · 2016: 5 · 2015: 2 · 2014: 3
- FWCI
- 4.36
- Type
- book chapter
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Handbook of experimental pharmacology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (R01DA033073, R01DA031927)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Receptor Mechanisms and Signaling
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neuropeptides and Animal Physiology
- Health Sciences › Medicine › Pharmacology › Cannabis and Cannabinoid Research
- Keywords
- beta-arrestin, mu-opioid receptor, CB1 receptor, opioid analgesia, cannabinoid analgesia, G protein-coupled receptors, biased agonists, G protein signaling, receptor internalization, pain management, opioid side effects
- MeSH terms
- beta-Arrestins, Analgesics, Analgesics, Opioid, Animals, Cannabinoids, Humans, Pain, Drug Design, Receptors, Opioid, mu, Arrestins, Receptors, G-Protein-Coupled, Receptor, Cannabinoid, CB1
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