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Based on the results of this study, if an opioid is both a substrate and inducer of P-gp, chronic treatment could result in higher blood brain barrier (BBB) P-gp expression, with a consequent decrease in CNS penetration and antinociception (i.e., pharmacokinetic tolerance)

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This inconsistency may reflect the inherent complexity, inter-individual variability, and dynamic nature of the gut microbial ecosystem

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