Department of Health Education and Behavior, University of Florida, Gainesville, FL, USA; Department of Psychology, University of Florida, Gainesville, FL, USA.
Department of Psychology, University of Florida, Gainesville, FL, USA; Department of Epidemiology, University of Florida, Gainesville, FL, USA.
Behav Processes. 2021 May;186:104344. doi: 10.1016/j.beproc.2021.104344. Epub 2021 Feb 2.
The demand for opioid medication to effectively treat pain has contributed to the surging opioid crisis, which is a major source of morbidity and mortality in the U.S. More than 100,000 people begin opioid maintenance treatment (OMT) annually, the standard pharmacotherapy for opioid use disorder (OUD). Although OMT is the standard care for OUD, patients often experience or develop a heightened sensitivity to pain (hyperalgesia) as a result of the opioid medication, and also have high rates of stress, affective, and anxiety-related conditions. These conditions are interactive with other behavioral and environmental correlates of opioid and other substance use disorders including impulsive decision-making (e.g., harmful opioid use associated with increased delay discounting), and a lack of alternative (i.e., substance-free) and social reinforcement. Collectively these complex and multifaceted factors constitute significant predictors of lack of adherence to OMT (and other pharmacotherapies) and relapse. There is an urgent need, therefore, to develop novel adjunctive treatments that preserve the benefits of OMT and various pharmacotherapies, and simultaneously diminish continued pain and hyperalgesia, reduce stress and anxiety-related conditions, target relevant behavioral mechanism such as impulsive choice, and also serve to enhance the value of alternative and substance free activities. Here, we discuss evidence that an environmental manipulation - access to greenspace and nature - could serve as a potential adjunctive treatment to standard pharmacotherapies by targeting multiple biological and behavioral mechanisms that standard pharmacotherapies do not address.
人们对阿片类药物的需求很大，目的是为了有效治疗疼痛，但这也导致了阿片类药物危机的爆发，这是美国发病率和死亡率上升的一个主要原因。每年都有超过 10 万人开始接受阿片类药物维持治疗（OMT），这是治疗阿片类药物使用障碍（OUD）的标准药物治疗方法。尽管 OMT 是 OUD 的标准治疗方法，但由于阿片类药物，患者经常会经历或发展出对疼痛的高度敏感（痛觉过敏），而且还会出现高频率的压力、情感和焦虑相关疾病。这些情况与其他行为和环境因素相互作用，这些因素与阿片类药物和其他物质使用障碍有关，包括冲动决策（例如，与增加延迟折扣相关的有害阿片类药物使用），以及缺乏替代（即无物质）和社会强化。这些复杂而多方面的因素共同构成了缺乏对 OMT（和其他药物治疗）的坚持和复发的重要预测因素。因此，迫切需要开发新的辅助治疗方法，这些方法既要保留 OMT 和各种药物治疗的益处，同时又要减轻持续的疼痛和痛觉过敏，减轻压力和焦虑相关疾病，针对冲动选择等相关行为机制，还要增强替代和无物质活动的价值。在这里，我们讨论了这样一种证据，即环境干预——接触绿地和自然——可以作为一种潜在的辅助治疗方法，针对标准药物治疗方法无法解决的多种生物和行为机制。
