Department of Psychiatry, Addiction Sciences Division, Medical University of South Carolina, Charleston, SC, United States.
Department of Psychiatry, Addiction Sciences Division, Medical University of South Carolina, Charleston, SC, United States; Ralph H. Johnson VA Medical Center, Charleston, SC, United States.
Drug Alcohol Depend. 2021 Aug 1;225:108755. doi: 10.1016/j.drugalcdep.2021.108755. Epub 2021 May 21.
Opioid use disorder (OUD) remains a public health crisis in the USA. Although stress and craving are common precipitants of substance use, no research to date has investigated the impact of laboratory-induced stress and craving on subsequent opioid use.
Participants (N = 31) were individuals with prescription OUD who completed a human laboratory study followed by a one-month follow-up visit. Participants were randomly assigned to either a stress task (i.e., Trier Social Tress Task; TSST) or a no-stress condition, and then all participants completed an opioid cue paradigm. Measures of subjective (e.g., stress, craving), and neuroendocrine (e.g., cortisol, dehydroepiandrosterone) reactivity were assessed before and after each task. Survival and regression models tested the association between reactivity to the laboratory tasks and a) time to first opioid use and b) amount of opioid use during follow-up.
On average, participants first used opioids 3.65 (SD = 2.08) days following the study. Craving after the opioid cue paradigm (B = 0.44, Exp(B) = 1.55, 95 % CI [1.06, 2.28], p = .02) and after the TSST/no-stress condition plus opioid cue paradigm (B = 1.06, Exp(B) = 2.88, 95 % CI [1.70, 4.85], p < .001) predicted time to first use. Additionally, there was a significant interaction between randomization to the TSST, stress reactivity, and amount of opioids used.
Findings demonstrate that elevated cue-induced craving, either in the context of a stressor or not, is associated with shortened time to opioid use, whereas stress reactivity impacts the amount of opioids consumed. Preliminary findings add to the literature on stress, craving and opioid use and implicate treatment.
阿片类药物使用障碍（OUD）仍是美国的公共卫生危机。尽管压力和渴望是物质使用的常见诱因，但迄今为止，没有研究调查实验室诱发的压力和渴望对随后的阿片类药物使用的影响。
参与者（N=31）为有处方 OUD 的个体，他们完成了一项人体实验室研究，随后进行了为期一个月的随访。参与者被随机分配到应激任务（即特里尔社会应激测试；TSST）或非应激条件下，然后所有参与者都完成了阿片类药物线索范式。在每个任务前后评估了主观（例如，压力、渴望）和神经内分泌（例如，皮质醇、脱氢表雄酮）反应的指标。生存和回归模型测试了实验室任务的反应与 a）首次使用阿片类药物的时间和 b）随访期间使用阿片类药物的量之间的关联。
平均而言，参与者在研究后首次使用阿片类药物的时间为 3.65（SD=2.08）天。阿片类药物线索范式后的渴望（B=0.44，Exp（B）=1.55，95%CI[1.06,2.28]，p=0.02）和 TSST/非应激条件加阿片类药物线索范式后的渴望（B=1.06，Exp（B）=2.88，95%CI[1.70,4.85]，p<.001）预测了首次使用的时间。此外，随机分配到 TSST、应激反应和使用阿片类药物的量之间存在显著的相互作用。
研究结果表明，无论是在应激源的情况下还是不在应激源的情况下，阿片类药物线索诱导的渴望增加都与阿片类药物使用的时间缩短有关，而应激反应则影响阿片类药物的消耗量。初步研究结果增加了关于应激、渴望和阿片类药物使用的文献，并暗示了治疗方法。
