Effects of extended-release naltrexone on the brain response to drug-related stimuli in patients with opioid use disorder
| Autor: | Anna Rose Childress, Kanchana Jagannathan, Zhenhao Shi, An-Li Wang, Charles P. O'Brien, Daniel D. Langleben, Victoria P. Fairchild |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male Narcotic Antagonists media_common.quotation_subject Prefrontal Cortex Neuroimaging Craving Nucleus accumbens Nucleus Accumbens Naltrexone Young Adult 03 medical and health sciences 0302 clinical medicine Humans Medicine Pharmacology (medical) Biological Psychiatry media_common business.industry Addiction Opioid use disorder Middle Aged Opioid-Related Disorders medicine.disease Magnetic Resonance Imaging Substance Withdrawal Syndrome 030227 psychiatry Psychiatry and Mental health Opioid Cue reactivity Delayed-Action Preparations Female Orbitofrontal cortex Cues medicine.symptom business Neuroscience Photic Stimulation 030217 neurology & neurosurgery Research Paper medicine.drug |
| Zdroj: | Journal of psychiatryneuroscience : JPN. 43(3) |
| ISSN: | 1488-2434 |
| Popis: | Background Heightened response to drug-related cues is a hallmark of addiction. Extended-release naltrexone (XR-NTX) is a US Food and Drug Administration-approved pharmacotherapy for relapse prevention in patients with opioid use disorder (OUD). In these patients, XR-NTX has been shown to reduce brain responses to opioid-related visual stimuli. To assess the biomarker potential of this phenomenon, it is necessary to determine whether this effect is limited to opioid-related stimuli and whether it is associated with key OUD symptoms. Methods Using functional MRI (fMRI), we measured the brain responses to opioid-related and control (i.e., sexual and aversive) images in detoxified patients with OUD before, during and after XR-NTX treatment. Craving and withdrawal severity were evaluated using clinician- and self-administered instruments during each session. Results We included 24 patients with OUD in our analysis. During XR-NTX treatment, we found reduced responses to opioid-related stimuli in the nucleus accumbens (NAcc) and medial orbitofrontal cortex (mOFC). The reduction in mOFC response was specific to the opioid-related stimuli. The reduced NAcc and mOFC opioid cue reactivity was correlated with reduction in clinician-assessed and self-reported withdrawal symptoms, respectively. Limitations The study was not placebo-controlled owing to ethical, safety and feasibility concerns. Conclusion Extended-release naltrexone reduces the NAcc and mOFC cue reactivity in patients with OUD. This effect is specific to opioid-related stimuli in the mOFC only. The reduction in neural response to opioid-related stimuli is more robust in patients with greater decline in withdrawal severity. Our results support the clinical utility of mesocorticolimbic cue reactivity in monitoring the XR-NTX treatment outcomes and highlight the link between opioid withdrawal symptomatology and neural opioid cue reactivity. |
| Databáze: | OpenAIRE |
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