Abstract
BackgroundMedications for opioid use disorder such as opioid agonist treatment (OAT, including methadone, buprenorphine) are the gold standard intervention for opioid use disorder (OUD). Persons with OUD have high rates of neurocognitive impairment and psychiatric and substance use disorders, but few studies have examined these characteristics in diverse patients initiating OAT in opioid treatment programs (OTPs). Additionally, in these individuals, poor neurocognitive functioning and psychiatric/other substance use disorders are associated with poor OUD treatment outcomes. Given rapid changes in the opioid epidemic, we sought to replicate findings from our pilot study by examining these characteristics in a large diverse sample of persons with OUD starting OTP-based OAT.MethodsNinety-seven adults with OUD (M age = 42.2 years [SD = 10.3]; M education = 11.4 years [SD = 2.3]; 27% female; 22% non-Hispanic white) were enrolled in a randomized longitudinal trial evaluating methadone versus buprenorphine/naloxone on neurocognitive functioning. All participants completed a comprehensive neurocognitive, psychiatric, and substance use evaluation within one week of initiating OAT.ResultsMost of the sample met criteria for learning (79%) or memory (69%) impairment. Half exhibited symptoms of current depression, and comorbid substance use was highly prevalent. Lifetime cannabis and cocaine use disorders were associated with better neurocognitive functioning, while depression was associated with worse neurocognitive functioning.ConclusionsLearning and memory impairment are highly prevalent in persons with OUD starting treatment with either methadone or buprenorphine/naloxone in OTPs. Depression and comorbid substance use are prevalent among these individuals, but neither impact learning or memory. However, depression is associated with neurocognitive impairment in other domains. These findings might allow clinicians to help persons with OUD starting OAT to develop compensatory strategies for learning and memory, while providing adjunctive treatment for depression.Trial Registration NCT, NCT01733693. Registered November 4, 2012, https://clinicaltrials.gov/ct2/show/NCT01733693.
Highlights
Medications for opioid use disorder such as opioid agonist treatment (OAT, including methadone, buprenorphine) are the gold standard intervention for opioid use disorder (OUD)
Methadone is most often provided in physician monitored, long-term outpatient opioid treatment programs (OTPs), and buprenorphine/naloxone is becoming increasingly common in the United States (U.S.) among individuals seeking treatment for OUD [2]
While these studies demonstrate adverse neurocognitive effects of chronic opioid use and describe cognitive characteristics of those already engaged in opioid agonist treatment, only two studies to our knowledge have characterized the neurocognitive profiles of persons with OUD who are starting OAT [5, 14]
Summary
Medications for opioid use disorder such as opioid agonist treatment (OAT, including methadone, buprenorphine) are the gold standard intervention for opioid use disorder (OUD). More recent studies have characterized cognitive impairments in persons with OUD already engaged in OAT with methadone [12] or buprenorphine [13] and have found similar domains of cognitive impairment (i.e., attention/working memory and executive functioning) While these studies demonstrate adverse neurocognitive effects of chronic opioid use and describe cognitive characteristics of those already engaged in opioid agonist treatment, only two studies to our knowledge have characterized the neurocognitive profiles of persons with OUD who are starting OAT [5, 14]. While these studies found impairments in several neurocognitive domains including learning, memory, executive functioning, and motor skills, both were limited by inadequate or outdated neurocognitive batteries and small sample sizes, suggesting that more research is needed to understand the neurocognitive characteristics of persons with OUD who initiate OAT in OTPs
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