Penn State College of Medicine, 500 University Drive, P.O. Box 850, Hershey, PA 17033, USA.
Penn State College of Medicine, Departments of Family and Community Medicine, Anesthesiology and Perioperative Medicine, and Public Health Sciences, 500 University Drive, P.O. Box 850, Hershey, PA 17033, USA.
Brain Res Bull. 2022 Oct 1;188:67-76. doi: 10.1016/j.brainresbull.2022.07.018. Epub 2022 Jul 25.
Effective identification of individuals at increased risk for developing opioid use disorder (OUD) could reduce the overdose fatalities and mitigate the harm of the opioid epidemic. Early evidence has linked certain subjective experiences during the first substance exposure to subsequent substance misuse. This is consistent with anecdotal evidence that "first response" to opioids may distinguish those who later develop OUD from those who do not, further suggesting individual differences in neural activity and responses to specific substances.
The objective of this scoping review was to evaluate the evidence on the relationship between the subjective first response to opioids and the risk of developing OUD.
Ovid MEDLINE search (through 1/29/2021), followed by the search for articles published by the first/senior authors (PubMed) and references citing (Web of Science Citing Reference) identified eligible publications, was focused on studies involving humans, published in English, and describing the initial subjective response to opioid exposure and its association with OUD development or its risk. Systematic data extraction was completed for each eligible study.
3364 title/abstracts and 48 full-text articles were reviewed. Four articles, describing six studies (526 adult participants) were eligible and included. These studies were methodologically heterogeneous, including 2 randomized controlled trials, and 1 case-control, and 3 cross-sectional studies, with small sample sizes, precluding data pooling and meta-analysis. Results suggested that individuals with OUD or at elevated risk for OUD (determined by the validated OUD risk assessment surveys) were more likely to report their "first opioid response" as euphoric compared to their counterparts.
Limited evidence suggests that subjectively-reported euphoric response to first opioid exposure could predict the OUD risk. Prospective studies are needed to evaluate the utility of assessing first response (e.g., via brief point-of-care screening surveys) for informing clinical decisions when prescribing opioids.
有效识别易患阿片类药物使用障碍（OUD）的个体可降低过量死亡人数并减轻阿片类药物流行带来的危害。早期证据表明，首次接触物质时的某些主观体验与随后的物质滥用有关。这与传闻证据一致，即“首次反应”阿片类药物可能区分出后来发展为 OUD 的人与不发展 OUD 的人，进一步表明个体对特定物质的神经活动和反应存在差异。
本范围综述旨在评估首次接触阿片类药物时的主观反应与发展为 OUD 的风险之间关系的证据。
通过 Ovid MEDLINE 搜索（截至 2021 年 1 月 29 日），随后搜索第一/资深作者发表的文章（PubMed）和引用文献（Web of Science 引文），确定了符合条件的出版物，这些出版物集中在涉及人类的研究上，以英文发表，并描述了对阿片类药物暴露的初始主观反应及其与 OUD 发展或其风险的关系。对每项符合条件的研究都完成了系统的数据提取。
共审查了 3364 篇标题/摘要和 48 篇全文文章。有 4 篇文章，描述了 6 项研究（526 名成年参与者）符合条件并被纳入。这些研究方法学上存在差异，包括 2 项随机对照试验和 1 项病例对照研究，以及 3 项横断面研究，样本量较小，无法进行数据合并和荟萃分析。结果表明，与对照组相比，患有 OUD 或有较高 OUD 风险（通过经过验证的 OUD 风险评估调查确定）的个体更有可能报告他们的“首次阿片类药物反应”为欣快。
有限的证据表明，首次接触阿片类药物时主观报告的欣快反应可预测 OUD 风险。需要前瞻性研究来评估评估首次反应（例如，通过简短的即时护理筛查调查）的效用，以便在开具阿片类药物时为临床决策提供信息。
