Long Term Suboxone™ Emotional Reactivity As Measured by Automatic Detection in Speech

Abstract

Addictions to illicit drugs are among the nation’s most critical public health and societal problems. The current opioid prescription epidemic and the need for buprenorphine/naloxone (Suboxone®; SUBX) as an opioid maintenance substance, and its growing street diversion provided impetus to determine affective states (“true ground emotionality”) in long-term SUBX patients. Toward the goal of effective monitoring, we utilized emotion-detection in speech as a measure of “true” emotionality in 36 SUBX patients compared to 44 individuals from the general population (GP) and 33 members of Alcoholics Anonymous (AA). Other less objective studies have investigated emotional reactivity of heroin, methadone and opioid abstinent patients. These studies indicate that current opioid users have abnormal emotional experience, characterized by heightened response to unpleasant stimuli and blunted response to pleasant stimuli. However, this is the first study to our knowledge to evaluate “true ground” emotionality in long-term buprenorphine/naloxone combination (Suboxone™). We found in long-term SUBX patients a significantly flat affect (p<0.01), and they had less self-awareness of being happy, sad, and anxious compared to both the GP and AA groups. We caution definitive interpretation of these seemingly important results until we compare the emotional reactivity of an opioid abstinent control using automatic detection in speech. These findings encourage continued research strategies in SUBX patients to target the specific brain regions responsible for relapse prevention of opioid addiction.

Do We Really Need to Continue Pharmacotherapy for Opioid Use Disorder (OUD) Indefinitely?

“…There are a number of reports of serious withdrawal symptoms in individuals using BUP [18,19]. additionally, long-term users of BUP (average 1.6 years) have difficulty experiencing pleasure and other emotions [20]. They discount happiness and tend to be unaware of the feeling of sadness and anxiety.…”

A Systematic, Intensive Statistical Investigation of Data from the Comprehensive Analysis of Reported Drugs (CARD) for Compliance and Illicit Opioid Abstinence in Substance Addiction Treatment with Buprenorphine/naloxone

“…Bup/nal in a number and variety of forms (e.g., Suboxone R and Zubsolve R ) and methadone, are the available FDA approved MAT for opioid maintenance therapy. The success of the acute use of bup/nal during treatment is qualified by the potential for addiction liability, and the antireward effects of long-term use (Elman, Borsook, & Volkow, 2013;Hill et al, 2013).…”

“…Outcome studies that include other cofactors such as the length of stay, and experiments that use other tools to access, for example, emotionality measures (Hill et al, 2013) and fMRI to investigate the neural mechanisms that elicit reward-seeking and relapse in addictive behaviors (Volkow, Fowler, Wang, Telang, & Baler, 2009) are encouraged. To further enlighten our understanding of the psychological status of recovering patients, larger studies are required.…”

“…Compliance with prescribed medication and nonabstinence during bup/nal maintenance treatment were measured in a single sample of analytes (Blum et al, 2011;Blum et al, 2014;Hill et al, 2013).…”

Neurogenetic and Epigenetic Correlates of Adolescent Predisposition to and Risk for Addictive Behaviors as a Function of Prefrontal Cortex Dysregulation

“…However, the rationale of such a blockade always remains questionable, as it strengthens the hypodopaminergic state of the brain reward circuits, and thus sustains the craving rather than helping the person achieve relief. Moreover, a recent study observed emotional impairment utilizing a sophisticated voice recognition method in long-term (average 1.6 years) patients on Suboxone maintenance therapy (Hill et al 2013). From this perspective, the importance of utilizing dopamine agonist therapy to treat addictive disorders instead of blocking natural dopaminergic activity seems more prudent in the long term (Blum et al, 2014a).…”