Abstract
Opioid use disorder (OUD) is a major public health issue that has reached epidemic levels in some parts of the world. It is a chronic and complex neurobiological disease associated with frequent relapse to drug taking. Craving, defined as an overwhelmingly strong desire or need to use a drug, is a central component of OUD and other substance use disorders. In this review, we describe the neurobiological and neuroendocrine pathways that underpin craving in OUD and also focus on the importance of assessing and treating craving in clinical practice. Craving is strongly associated with patients returning to opioid misuse and is therefore an important treatment target to reduce the risk of relapse and improve patients’ quality of life. Opioid agonist therapies (OAT), such as buprenorphine and methadone, can significantly reduce craving and relapse risk, and it is essential that patients are treated optimally with these therapies. There is also evidence to support the benefits of non-pharmacological approaches, such as cognitive behavioral therapy and mindfulness-based interventions, as supplementary treatments to opioid agonist therapies. However, despite the positive impact of these treatments on craving, many OUD patients continue to suffer with negative affect and dysphoria. There is a clear need for further studies to progress our understanding of the neurobiological basis of craving and addiction and to identify novel therapeutic strategies as well as to optimize the use of existing treatments to improve outcomes for the growing numbers of patients affected by OUD.
Highlights
Opioid use disorder (OUD) is a major public health burden worldwide and is associated with substantial mortality and morbidity [1, 2]
Craving is a common symptom across substance use disorders beyond opioids, including those relating to alcohol, nicotine, cannabis, cocaine, and other psychoactive substances [11]
We focus our discussion on the neurobiology of addiction based on the cycle of addiction developed by Koob and colleagues [22] (Figure 1)
Summary
Opioid use disorder (OUD) is a major public health burden worldwide and is associated with substantial mortality and morbidity [1, 2]. A key component of OUD is the development of longlasting drug craving [3,4,5], whether in the context of prescribed opioids, such as for analgesic purposes, or illicitly acquired heroin. Craving is included within the definition of opioid dependence in the recently updated 11th Revision of the International Classification of Diseases system [11]. Craving is a common symptom across substance use disorders beyond opioids, including those relating to alcohol, nicotine, cannabis, cocaine, and other psychoactive substances [11]. There have been several articles in recent years reviewing data in drug craving [9, 12], a focused review of opioid-specific evidence is lacking. The PubMed database was searched using terms related to opioids and craving. Additional references were identified through searching the bibliographies of retrieved articles
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
