Opioid Use Disorder Recovery Research Articles

Insomnia symptoms and neurofunctional correlates among adults receiving buprenorphine for opioid use disorder.

Insomnia symptoms are negatively related to opioid use disorder (OUD) treatment outcomes, possibly reflecting the influence of sleep on neurofunctional domains implicated in addiction. Moreover, the intersection between OUD recovery and sleep represents an area well-suited for the development of novel, personalized treatment strategies. This study assessed the prevalence of clinically significant insomnia symptoms and characterized its neurofunctional correlates among a clinical sample of adults with OUD receiving buprenorphine. Adults (N = 129) receiving buprenorphine for OUD from an outpatient clinic participated in a cross-sectional survey. Participants completed an abbreviated version of NIDA's Phenotyping Assessment Battery, which assessed 6 neurofunctional domains: sleep, negative emotionality, metacognition, interoception, cognition, and reward. Bivariate descriptive statistics compared those with evidence of clinically significant insomnia symptoms (Insomnia Severity Index [ISI] score of ≥11) to those with minimal evidence of clinically significant insomnia symptoms (ISI score of ≤10) across each of the neurofunctional domains. Roughly 60% of participants reported clinically significant insomnia symptoms (ISI score of ≥11). Experiencing clinically significant insomnia symptoms was associated with reporting greater levels of depression, anxiety, post-traumatic stress, stress intolerance, unhelpful metacognition, and interoceptive awareness (ps<0.05). Participants with evidence of clinically significant insomnia were more likely to report that poor sleep was interfering with their OUD treatment and that improved sleep would assist with their treatment (ps<0.05). Insomnia was prevalent among adults receiving buprenorphine for OUD. Insomnia was associated with neurofunctional performance, which may impact OUD treatment trajectories. Our findings indicate potential targets in the development of personalized treatment plans for patients with co-morbid insomnia and OUD. To inform the development of novel treatment strategies, more research is needed to understand the potential mechanistic links between sleep disturbances and substance use.

Health-related quality of life and recovery capital among recovery residents taking medication for opioid use disorder in Texas.

Recovery from opioid use disorder (OUD) includes improvements in health-related quality of life (HRQOL) and is supported by recovery capital (RC). Little is known about RC and HRQOL among recovery residents taking medication for OUD. We described HRQOL and RC and identified predictors of HRQOL. Project HOMES is an ongoing longitudinal study implemented in 14 recovery homes in Texas. This is a cross-sectional analysis of data from 358 participants' on HRQOL (five EQ-5D-5L dimensions-mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) and RC (Assessment of Recovery Capital scores) collected from April 2021 to June 2023. Statistical analyses were conducted using T-, Chi-squared, and Fisher's exact tests. Most participants were 35 years/older (50.7%), male (58.9%), non-Hispanic White (68.4%), heterosexual (82.8%), and reported HRQOL problems, mainly anxiety/depression (78.4%) and pain/discomfort (55.7%). Participants who were 35 years/older [mean (SD) = 42.6 (7.3)] were more likely to report mobility and pain/discomfort problems than younger participants. Female participants were more likely to report pain/discomfort problems than male participants. Sexual minorities were more likely to report anxiety/depression problems than heterosexual participants. Married participants and those in committed relationships were more likely to report problems conducting self-care than single/never-married participants. Comorbid conditions were associated with mobility, pain/discomfort, and usual activities problems. Most participants reported high social (65.4%), personal (69.0%), and total (65.6%) RC. Low personal RC was associated with mobility (aOR = 0.43, CI = 0.24-0.76), self-care (aOR = 0.13, CI = 0.04-0.41), usual activities (aOR = 0.25, CI = 0.11-0.57), pain/discomfort (aOR = 0.37, CI = 0.20-0.68), and anxiety/depression (aOR = 0.33, CI = 0.15-0.73) problems. Low total RC was associated with problems conducting self-care (aOR = 0.20, CI = 0.07-0.60), usual activities (aOR = 0.43, CI = 0.22-0.83), pain/discomfort problems (aOR = 0.55, CI = 0.34-0.90), and anxiety/depression (aOR = 0.20, CI = 0.10-0.41) problems. Social RC was not associated with HRQOL. Personal and total RC and comorbid conditions predict HRQOL. Although the opioid crisis and the increasing prevalence of comorbidities have been described as epidemics, they are currently being addressed as separate public health issues. Our findings underscore the importance of ensuring residents are provided with interprofessional care to reduce the burden of comorbidities, which can negatively impact their OUD recovery. Their RC should be routinely assessed and enhanced to support their recovery and improve HRQOL.

0693 Rest-activity rhythm in Methadone and Buprenorphine-maintained patients

Abstract Introduction Opioid use disorder (OUD) is a chronic relapsing disorder with a high overdose death rate. In OUD, sleep and circadian disruptions are highly prevalent, interfere with retention in opioid maintenance treatment (OMT) and increase relapse. Growing evidence suggests a link between sleep/circadian disruptions and dopaminergic (DA) signaling which accounts for addictive properties of drugs of abuse. The current study investigated rest-activity rhythm in Methadone and Buprenorphine-maintained patients and how it relates to DA changes in patients. Methods To access rest-activity rhythm, twenty-five OUD patients (9 Females; age 44.34±11.97; 60% White, 32% Black; 18 Methadone; 7 Buprenorphine) and thirty-four age, sex, race and BMI-matched healthy controls wore wrist accelerometers for one-week and completed questionnaires for sleep and chronotype. Among OUD patients, sixteen of them completed [11C]NNC112 and [11C]raclopride PET scans for the assessments of D1R and D2R availability, respectively. Negative mood was accessed as secondary outcomes. Results Our preliminary data showed that compared to healthy participants, OUD patients undergoing OMT reported greater sleep problems and showed greater sleep irregularity measured by actigraphy, but no differences in other parameters such as sleep duration, rhythm timing or physical activity. Among patients, greater eveningness and irregularity were associated with higher level of negative mood including depression and anxiety. There is a tendency of a positive correlation between later phase and greater D1 receptor availability and a negative association between sleep irregularity and D2 receptor availability. Conclusion Our finding suggests that a link between altered rest-activity rhythm and DA signaling in OUD patients. Circadian/sleep interventions that regulate rest-activity rhythm might benefit mood improvement and promote OUD recovery by normalizing DA transmission. Support (if any)

Increasing Peer Support for Opioid Use Disorder Recovery During COVID-19 Through Digital Health: Protocol for a National Randomized Controlled Trial

Background Increasing numbers of opioid overdoses have been observed during the COVID-19 pandemic, likely reflecting the pandemic’s multiple effects on this already vulnerable population. People in recovery from opioid use disorder (OUD) have reported disproportionate psychosocial distress and isolation, as well as significant disruptions in access to treatment, including peer support, during the COVID-19 pandemic. Peer support is a key component of many evidence-based OUD recovery programs; it improves recovery capital, treatment engagement, and perceived social support and reduces psychosocial distress, particularly when used in conjunction with other evidence-based treatments, such as medication for OUD. Objective This study aims to evaluate a novel mobile peer support app platform among a national sample of individuals in recovery from OUD as an adjunct to usual care during the COVID-19 pandemic. Methods Individuals residing in the United States who are aged ≥18 years; own a smartphone; and self-report being in recovery for an OUD, being in treatment for an OUD (ie, in the past 30 days received prescribed methadone, naltrexone, or buprenorphine), or currently receiving some form of assisted recovery support (n=1300) will be recruited through online, targeted social media advertisements. Eligible participants will be randomly assigned (1:1) to a mobile peer recovery support intervention utilizing a novel smartphone-based app or to a control. Participants will complete 1 baseline survey and then a follow-up survey 1, 3, and 6 months after randomization. The primary aim of recovery capital will be determined by the change in recovery capital between study groups over the 6-month study period. We will also examine treatment engagement by using administrative data from a subset of individuals (n=650) residing in Rhode Island and Indiana. Results As of June 2022, we enrolled 43 participants. Conclusions If this mobile app demonstrates efficacy among a large national sample of patients, it has the potential to augment existing treatment programs, improve recovery capital, and reduce the disproportionate impacts of COVID-19 on this vulnerable population. Conflicts of Interest None declared. Trial Registration ClinicalTrials.gov NCT05405712; https://clinicaltrials.gov/ct2/show/NCT05405712

Integrated hepatitis C treatment is associated with improved retention and success in outpatient treatment for opioid use disorder at a private clinic.

BackgroundDirect acting antiretrovirals (DAA) are effective for individuals who are infected with chronic hepatitis C virus (HCV), yet many people go without access to these lifesaving treatments.Materials and methodsWe conducted a non-randomized study evaluating treatment data for patients in outpatient treatment for opioid use disorder (OUD) at a private clinic. Patients who were HCV-positive, had been in OUD treatment for at least 4 weeks, and engaged in integrated HCV treatment with DAA (co-located within their treatment for OUD) were compared to patients with HCV who only received OUD treatment. We evaluated HCV cure; OUD medication adherence, treatment utilization and retention; and illicit substance use for those engaged in treatment between 9/2016 and 1/2018.ResultsSeventy-four patients completed integrated HCV-OUD treatment with DAA, with 87.8% achieving cure. Of the 66 who completed treatment and were subsequently evaluated for sustained viral response 98.5% were cured. Patients who received integrated HCV and OUD treatment in our clinic, stayed in OUD treatment longer, demonstrated higher OUD medication adherence, and used less opioids or cocaine compared to HCV-infected patients (n = 572) being treated only for OUD.DiscussionWe have reported on a reproducible intervention that lends itself to outpatient OUD treatment. Analyses demonstrate the potential positive impact HCV treatment has on OUD recovery, including reduction in opioid and cocaine use and increased retention in careConclusionCo-locating HCV treatment with existing OUD treatment is feasible, effective, and demonstrates positive outcomes for the treatment of both conditions.

Centering culture in the treatment of opioid use disorder with American Indian and Alaska Native Communities: Contributions from a National Collaborative Board.

American Indian/Alaska Native (AI/AN) communities are disproportionally impacted by the opioid overdose epidemic. There remains a dearth of research evaluating methods for effectively implementing treatments for opioid use disorder (OUD) within these communities. We describe proceedings from a 2-day Collaborative Board (CB) meeting tasked with developing an implementation intervention for AI/AN clinical programs to improve the delivery of medications to treat OUD (MOUD). The CB was comprised of Elders, cultural leaders, providers, individuals with lived experience with OUD, and researchers from over 25 communities, organizations, and academic institutions. Conversations were audio-recorded, transcribed, and coded by two academic researchers with interpretation oversight provided by the CB. These proceedings provided a foundation for ongoing CB work and a frame for developing the program-level implementation intervention using a strength-based and holistic model of OUD recovery and wellbeing. Topics of discussion posed to the CB included engagement and recovery strategies, integration of extended family traditions, and addressing stigma and building trust with providers and clients. Integration of traditional healing practices, ceremonies, and other cultural practices was recommended. The importance of centering AI/AN culture and involving family were highlighted as priorities for the intervention.

Types and Sources of Stigma on Opioid Use Treatment and Recovery Communities on Reddit

Background: Digitally-mediated peer support may improve opioid use disorder (OUD) recovery. Our objective was to examine the types and sources of stigma that people seek support for in online OUD recovery communities (subreddits) on Reddit. Methods: We extracted all posts containing stigma keywords from three subreddits as well as a random sample that do not contain stigma keywords. We conducted deductive content analysis to confirm that the post self-described an experience of stigma and identify the type (condition, intervention) and source (provider-based, public, self, structural) of stigma. Results: Two-hundred and fifty-nine posts self-reported a stigmatizing experience. The majority of posts described an intervention stigma associated with medications for OUD. Posts discussing intervention stigma acknowledged the role of stigma in their treatment decision-making and quality of their treatment program. The most frequent sources of stigma were the public (including family members), provider-based (healthcare and pharmacy workers), structural (workplace, law enforcement, child protective services, and abstinence-based self-help groups), and self. No posts mentioned courtesy stigma. Posts sought assistance in navigating their experiences and participating in advocacy to counter stigmatized narratives. Conclusions: Our study indicates that people in online communities seek support to disclose and manage experiences of stigma on Reddit in similar ways to people in offline communities with the noted exception of an absence of discussions of courtesy stigma. Since each subreddit is a microcosm of varying needs, we suggest areas of future work for collaborative resources developed between stakeholders of these subreddits and public health that work within the preexisting Reddit social norms.

R‐(‐)2,5‐dimethoxy‐4‐iodoamphetamine (DOI) Blunts the Discriminative Stimulus Properties of Oxycodone

AimsA record ~100,000 fatalities due to drug overdoses was reported in the U.S. for the twelve months preceding April 2021. Opioids account for most deaths, and recurrent opioid use may lead to the development of opioid use disorder (OUD), a debilitating chronic disorder. Current medication‐assisted OUD treatment (e.g., buprenorphine) mitigates withdrawal, reduces mortality, and reduces intake of abused opioids. Still, the opioid epidemic crystalized the need to identify novel non‐opioid therapeutics to improve the odds of successful OUD recovery. In the last decade, there has been a resurgence of interest in serotonergic psychedelics for the treatment of psychiatric disorders, including substance use disorders. Psychedelic compounds act through agonist actions at the serotonin (5‐HT) 5‐HT2A receptor (5‐HT2AR) and there is some literature to suggest functional interactions between 5‐HT2AR and opioids. We tested the hypothesis that the psychedelic 5‐HT2AR agonist R‐(‐)2,5‐dimethoxy‐4‐iodoamphetamine (DOI) will disrupt the discriminative stimulus properties of the commonly misused prescription opioid oxycodone. The drug discrimination paradigm is a rigorous laboratory procedure for modeling the interoceptive effects of drugs and is widely recognized as useful in establishing ligand potency and effectiveness in vivo, as well as interrogating abuse liability.MethodsMale, Sprague‐Dawley rats (n = 13) were trained to discriminate an injection (s.c.) of oxycodone (1 mg/kg) from saline (1 ml/kg) in a two‐lever, water‐reinforced paradigm. Pharmacological testing began upon establishment of the stable oxycodone vs. saline discrimination. Substitution tests with DOI (0‐0.2 mg/kg; s.c.) and combination tests with DOI plus oxycodone were conducted interspersed with maintenance sessions. Percent oxycodone‐lever responding, response rates and latency to the first response were analyzed with an experimentwise error rate of α=0.05.ResultsAll rats acquired the oxycodone vs. saline discrimination to stability. Substitution tests indicated that all DOI doses resulted in percent oxycodone‐lever responding significantly different from the training dose of oxycodone (p&lt; 0.05). Pretreatment with DOI (0.1, 0.2 mg/kg) significantly reduced the percent oxycodone‐lever responding (0.5 mg/kg), relative to pretreatment with vehicle (p &lt; 0.05). The selective 5‐HT2AR antagonist M100907 prevented DOI‐induced suppression of oxycodone‐lever responding (p &lt; 0.05).ConclusionsThe current studies reveal that the psychedelic DOI does not substitute for oxycodone, but does suppress the stimulus effects of oxycodone, an effect which is reversed by the 5‐HT2AR antagonist M100907. Taken together, these studies provide support for expanded interrogation of the efficacy of 5‐HT2AR agonists in counteracting the behavioral effects of opioids.

Worsening sleep quality across the lifespan and persistent sleep disturbances in persons with opioid use disorder.

Individuals with opioid use disorder (OUD) may experience worsening sleep quality over time, and a subset of individuals may have sleep disturbances that precede opioid use and do not resolve following abstinence. The purpose of the present study was to (1) collect retrospective reports of sleep across the lifespan and (2) identify characteristics associated with persistent sleep disturbance and changes in sleep quality in persons with OUD. Adults with OUD (n = 154) completed a cross-sectional study assessing current and past sleep disturbance, opioid use history, and chronic pain. Repeated-measures analysis of variance was used to examine changes in retrospectively reported sleep quality, and whether changes varied by screening positive for insomnia and/or chronic pain. Multivariate linear regression analyses were used to identify additional correlates of persistent sleep disturbance. Participants reported that their sleep quality declined over their lifespan. Changes in reported sleep over time varied based on whether the individual screened positive for co-occurring insomnia and/or chronic pain. In regression analyses, female sex (β = 0.16, P = .042), a greater number of treatment episodes (β = 0.20, P = .024), and positive screens for chronic pain (β = 0.19, P = .018) and insomnia (β=0.22, P = .013) were associated with self-reported persistent sleep disturbance. Only a portion of participants who screened positive for sleep disorders had received a formal diagnosis. OUD treatment providers should routinely screen for co-occurring sleep disturbance and chronic pain. Interventions that treat co-occurring OUD, sleep disturbance, and chronic pain are needed. Ellis JD, Mayo JL, Gamaldo CE, Finan PH, Huhn AS. Worsening sleep quality across the lifespan and persistent sleep disturbances in persons with opioid use disorder. J Clin Sleep Med. 2022;18(2):587-595.

Chronic Pelvic Pain and Sexual Dysfunction Among Females and Males Receiving Treatment for Opioid Use Disorder

Introduction: Chronic pain brings complexity to opioid use disorder (OUD). Psychosocial and neurobiological risks for Chronic Pelvic Pain (CPP) and OUD overlap. The primary objective of this exploratory study is to compare sex-specific prevalence of CPP and sexual dysfunction between individuals receiving buprenorphine for OUD and a comparison group receiving treatment for other chronic medical conditions (CMC).Methods: Participants from an OUD treatment (n = 154) and primary care clinic (n = 109) completed a survey between July 2019 and February 2020 assessing reproductive and sexual health. Sex-stratified CPP and pain interference measures were adapted from the Brief Pain Inventory for females, and for males, the Brief Male Sexual Function Inventory and NIH Chronic Prostatitis Symptom Index. The Male and Female Sexual Function Index assessed sexual dysfunction. Prevalence of CPP and sexual dysfunction between groups were compared using Pearson χ2 and Fisher's Exact tests.Results: Participants were 54.4% female and 75.0% Black with almost half having a psychiatric diagnosis. Among OUD females, the highest pain severity reported was for menstrual-related pain, and for OUD males, testicular pain. CPP most interfered with mood in OUD females vs. sleep and enjoyment of life in OUD males. There were no differences in prevalence for global sexual dysfunction with 91.6% of females and 84.2% of males screening positive across groups.Discussion/Implications: CPP and sexual dysfunction are important components of wellness and may play a role in OUD recovery trajectories. The value of addressing CPP and sexual dysfunction in tailored comprehensive, sex-informed OUD treatment approaches should be further investigated.

Doula engagement and maternal opioid use disorder (OUD): Experiences of women in OUD recovery during the perinatal period

BackgroundPregnant women who have substance use disorders (SUDs) are at increased risk of preterm birth, fetal mortality, and inadequate prenatal care and have higher rates of childhood trauma than their counterparts without SUDs. Doulas have been utilized with other vulnerable populations who experience trauma to increase perinatal healthcare utilization, provide emotional support, and improve birth outcomes. The objective of the current study was to examine, in women with opioid use disorder (OUD), perceptions of working with a doula in the perinatal period. MethodsEligible participants were ≥ 18 years old, in OUD treatment, and were pregnant or recently delivered (child ≤ 3 months of age). Semi-structured interviews were used to collect tacit data on the woman's experience working with a doula during the perinatal period. All one-hour interviews were conducted over the phone and transcribed verbatim by a HIPAA compliant transcription service. Transcripts were reviewed independently by 4 coders using open coding procedures, constant comparative method of grounded theory, and inductive thematic analysis. Demographic data and history of childhood trauma information (Adverse Childhood Experiences Tool) were collected with a phone survey prior to the interview. ResultsParticipants’ (N = 23) were 32.5 years of age (4.1 SD), with the majority Caucasian (71.4%), Non-Hispanic (71.4%) and Medicaid recipients (100%). Participants reported a mean of 5.61 (SD=2.93) adverse childhood experiences, indicating a significant trauma burden. Major themes uncovered in the interview transcripts revealed emotional and OUD recovery support provided by the doula and increased maternal health literacy and self-advocacy. The presence of a doula during labor/delivery reduced maternal perceptions of stigma they perceived from their healthcare providers. ConclusionDoula engagement was associated with perceptions of increased emotional support, health literacy and self-advocacy in maternal health among women with OUD, which is significant given this population's trauma histories. This preliminary research has significant implications for improving the health of the mother child dyad affected by maternal OUD.

Postpartum and addiction recovery of women in opioid use disorder treatment: A qualitative study

Background Postpartum is a highly vulnerable time for women with opioid use disorder (OUD). Our primary objective was to identify patient and provider reported aspects of the pregnancy to postpartum transition that impact recovery progress for postpartum women receiving medication for opioid use disorder (MOUD). Methods: This qualitative study consisted of semi-structured interviews with postpartum women in OUD treatment (n = 12) and providers (n = 9) at an outpatient addiction clinic. Interviews were transcribed and analyzed using an editing style approach to report themes and quotes. Results: Patients and providers identified different themes that both promote and challenge recovery during the postpartum transition. These comprised of clinical factors, including MOUD, neonatal opioid withdrawal syndrome (NOWS) and pain associated with labor and delivery as well as psychosocial factors, such as role of a support system, mental health aspects of anxiety and depression causing mood changes, stigma and mistrust among healthcare providers and child welfare. Conclusions: Patients receiving MOUD and their providers identified multiple aspects unique to the postpartum transition that substantially strengthen and/or oppose OUD recovery. These aspects impacting recovery include factors specific to the receipt of MOUD treatment and those not specific to MOUD, yet tied to the postpartum state. Overall, these findings provide insight into areas for future research focused on identifying opportunities to promote recovery-oriented care for families affected by OUD.

784 Naturalistic Measurement of Sleep/Wake Disturbance in Adults Receiving Methadone Treatment for Opioid Use Disorder

Abstract Introduction Individuals with opioid use disorder (OUD) report significant sleep/wake disturbance, which continues even after stabilization on medication-assisted treatment (MAT). However, the nature of sleep/wake disturbance in this population has not been well documented objectively. Here we analyze naturalistic wrist actigraphy recordings in individuals with OUD receiving methadone-based MAT. Methods Seven adults undergoing methadone treatment for OUD (ages 26–50; 4 women) wore a wrist actigraph (Actiwatch-2, Philips Respironics) continuously for 7 days. They were asked to adhere to their normal sleep schedule in order to obtain naturalistic observations. Reference data were collected in a separate study of healthy controls, in which 14 hospital nurses (ages 20–60; 13 women) wore a wrist actigraph continuously for 7 days. In this reference group, 7 participants had a day shift schedule (07:00–19:00) and 7 had a night shift schedule (19:00–07:00), with six 12h shifts in a 2-week period. Actigraphic data were collected in 1min epochs, and the sleep/wake status for each epoch was estimated using Actiware 6.0.9 (Philips Respironics). The estimated sleep/wake patterns were subjected to cosinor analysis to assess 24h rhythmicity and analysis of the distribution of inactive periods to assess sleep continuity. Results For the reference group, nurses working day shifts displayed strong 24h rhythmicity, whereas nurses working night shifts showed blunted 24h rhythmicity (F[1,12]=66.11, p&amp;lt;0.001). However, both day and night nurses exhibited high sleep continuity (KS test, p=0.82). By contrast, for the group with OUD receiving methadone, the strength of 24h rhythmicity was reduced to between that of the day and night shift nurses in the reference group, indicating weak regularity of sleep/wake patterns (F[2,18]=33.79, p&amp;lt;0.001). Furthermore, individuals with OUD receiving methadone experienced low sleep continuity compared to the reference group (KS test, p=0.030). Conclusion These naturalistic observations confirm the presence of sleep/wake disturbance, resulting from both irregular sleep/wake patterns and low sleep continuity, in individuals receiving methadone-based MAT for OUD. Sleep/wake disturbance may interfere with the ability to achieve OUD recovery goals, and comparing sleep disturbance in MAT populations to reference data highlights the need to consider sleep in these populations as a clinical priority. Support (if any) State of Washington Initiative Measure No. 171

Patient and Clinician Perspectives on Adolescent Opioid Use Disorder Treatment During a Pandemic: One Step Back, but Two Forward?

Opioid use disorder (OUD) is one of the most pressing public health problems in the United States and is highly prevalent among adolescents and young adults (AYAs). However, only a small percentage of AYAs with OUD ever receive treatment. Further, among those that do receive treatment, a substantial proportion of patients continue to struggle with OUD, and many prematurely drop out of treatment. These challenges have only been heightened in the face of the COVID-19 pandemic, but greater utilization of telehealth and mobile technologies by OUD patients may help counter these barriers, which ultimately may improve AYA OUD treatment in the postpandemic period. This viewpoint presents the perspective of a person in OUD recovery using online and mobile technology to support his own OUD recovery combined with thoughts from two clinicians supporting AYAs with OUD. Their perspectives may provide insights to help counter COVID-19–related consequences and offer clues to improving AYA OUD treatment in the long term.

1038 Sleep Architecture In Individuals Receiving Methadone For Medication-Assisted Treatment Of Opioid Use Disorder

Abstract Introduction It has been established that the use of opioids suppresses stage N3 sleep. For individuals with opioid use disorder (OUD), medication-assisted treatment (MAT) is a widely employed opioid replacement therapy used to mitigate withdrawal effects and drug cravings. We investigated sleep architecture in individuals receiving methadone-based MAT. Methods N=6 individuals (aged 43.8±12.8y; 5 females), who were within 90 days of methadone initiation, underwent in-laboratory overnight polysomnography (8h TIB; 22:00-06:00). Prior to bedtime, pain intensity and opioid withdrawal symptoms were assessed using the Numeric Pain Rating Scale (0-10) and the Clinical Opiate Withdrawal Scale (0-48). Sleep recordings were scored visually according to AASM guidelines. Results In this sample, subjects exhibited 87.4-93.0% (M: 92.2%) sleep efficiency (SE), 8.0-16.2min (M: 12.1min) sleep latency (SL), 5.5-7.5% (M: 6.5%) N1, 46.4-52.7% (M: 49.6%) N2, 20.7-30.6% (M: 25.6%) N3, 17.5-19.1% (M: 18.3%) REM, 28.0-38.5min (M: 33.3min) N3 latency, and 84.1-125.9min (M: 105.0min) REM latency. Subjects reported moderate pain intensity scores of 5-6 (M: 5.3) and mild to moderate withdrawal symptoms of 1-15 (M: 7.8). Conclusion Relative to published healthy sleeper norms, subjects showed more N1 and N3 and less REM sleep. The increased N3 was unexpected given that opioids (such as methadone) typically suppress N3; it may reflect subjects carrying a substantial sleep debt. Pain and withdrawal symptoms may be a factor increasing N1 and reducing REM sleep. Such potential sleep deficiencies may interfere with subjects achieving OUD recovery goals and are worthy of further investigation. Support Supported in part by a seed grant from the Washington State University Office of Research Advancement and Partnerships.

Recovery From Opioid Use Disorder (OUD) After Monthly Long-acting Buprenorphine Treatment: 12-Month Longitudinal Outcomes From RECOVER, an Observational Study.

Objectives:While evidence has mounted regarding the short-term effectiveness of pharmacotherapy for opioid use disorder (OUD), little is known about longer-term psychosocial, economic, and health outcomes. We report herein 12-month outcomes for an observational study enrolling participants who had previously taken part in a long-acting buprenorphine subcutaneous injection (BUP-XR) trial for moderate to severe OUD.Methods:The RECOVER (Remission from Chronic Opioid Use: Studying Environmental and SocioEconomic Factors on Recovery; NCT03604861) study enrolled participants from 35 US community-based sites. Self-reported sustained opioid abstinence over 12 months and self-reported past-week abstinence at 3-, 6-, 9-, and 12-month visits were assessed. Multiple regression models assessed the association of BUP-XR duration with abstinence, controlling for potential confounders. Withdrawal, pain, health-related quality of life, depression, and employment at RECOVER baseline and 12-month visits were also compared to values collected before treatment in the BUP-XR trial.Results:Of 533 RECOVER participants, 425 completed the 12-month visit (average age 42 years; 66% male); 50.8% self-reported sustained 12-month and 68.0% past-week opioid abstinence. In multiple regressions, participants receiving 12-month versus ≤2-month BUP-XR treatment duration had significantly higher likelihood of sustained opioid abstinence (75.3% vs 24.1%; P = 0.001), with similar results for past-week self-reported abstinence over time. During RECOVER, participants had fewer withdrawal symptoms, lower pain, positive health-related quality of life, minimal depression, and higher employment versus pre-trial visit.Conclusions:RECOVER participants reported positive outcomes over the 12-month observational period, including high opioid abstinence and stable or improved humanistic outcomes. These findings provide insights into the long-term impact of pharmacotherapy in OUD recovery.

Increased neural activity in the right dorsolateral prefrontal cortex during a risky decision-making task is associated with cocaine use in methadone-maintained patients

BackgroundMethadone maintenance is an effective treatment for opioid use disorder (OUD), yet many methadone-maintained patients (MMPs) struggle with cocaine use during OUD recovery. The current study aimed to identify whether prefrontal cortex (PFC) activity during a risky decision-making task was associated with cocaine use during a 90-day follow-up in MMPs. MethodsMMPs (N = 28) attended a single neuroimaging session wherein PFC activity was measured using functional near-infrared spectroscopy (fNIRS) during the Balloon Analogue Risk Task (BART). Trait impulsivity was assessed via the Barratt Impulsiveness Scale version 11 (BIS-11). Following the neuroimaging session, MMPs were tracked via electronic health records for 90 days to determine treatment outcomes including cocaine use verified by urine drug screens. ResultsDuring the BART, MMPs who used cocaine displayed increased neural activity in the right PFC during active decision-making (F1, 22 = 14.75, p = 0.001) and the right dorsolateral PFC during active minus passive decision-making (F1, 22 = 5.56, p = 0.028) compared to participants who did not use cocaine. Receiver operating characteristic curves confirmed that neural activity in the right PFC during active decision-making (AUC = 0.841, 95% CI, 0.697-0.985, p = 002), and in the right dorsolateral PFC during active minus passive decision-making (AUC = 0.805, 95% CI, 0.643-0.968, p = 0.006) was associated with continued cocaine use. MMPs who used cocaine versus those who did not reported increased trait impulsivity on the BIS-11 Total Score (t=-2.28, p = 0.031). ConclusionsThe fNIRS device is portable, relatively easy to use, and potentially feasible for use in methadone outpatient programs to assess propensity for negative treatment outcomes such as continued cocaine use.

Review: Sex-Based Differences in Treatment Outcomes for Persons With Opioid Use Disorder.

In order to address the current opioid crisis, research on treatment outcomes for persons with opioid use disorder (OUD) should account for biological factors that could influence individual treatment response. Women and men might have clinically meaningful differences in their experience in OUD treatment and might also have unique challenges in achieving successful, long-term recovery. This review summarizes and synthesizes the current literature on sex-based differences in OUD treatment outcomes. Relevant literature was identified via automated and manual searches using the terms "opioid treatment outcome sex [or gender] differences" and "opiate treatment outcome sex [or gender] differences." Search methodology was consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and were conducted within the PubMed electronic database during March and April of 2018. The initial PubMed search yielded 241 manuscripts and 31 original research articles that met inclusion/exclusion criteria were synthesized in this review. Several important trends emerged, including findings that women are more likely than men to present to treatment with co-occurring mental health conditions such as depression, and that women might respond particularly well to buprenorphine maintenance. While much of the literature on this topic is subject to potential cohort effects, interventions that address co-occurring mental health conditions and psychosocial stress might improve treatment outcomes for women with OUD. Funding agencies and researchers should focus attention toward human laboratory studies and clinical trials that are prospectively designed to assess sex-based differences in OUD recovery. (Am J Addict 2019;28:246-261).