Resting-State Neuroimaging and Neuropsychological Findings in Opioid Use Disorder during Abstinence: A Review

Abstract

Dependence to opiates, including illicit heroin and prescription pain killers, and treatment of the opioid use disorder (OUD) have been longstanding problems over the world. Despite intense efforts to scientific investigation and public health care, treatment outcomes have not significantly improved for the past 50 years. One reason behind the continuing use of heroin worldwide despite such efforts is its highly addictive nature. Brain imaging studies over the past two decades have made significant contribution to the understanding of the addictive properties as to be due in part to biological processes, specifically those in the brain structure and function. Moreover, traditional clinical neuropsychology studies also contribute to the account in part for the treatment-refractory nature of the drug abuse. However, there is a gap between those studies, and the rates of relapse are still high. Thus, a multidisciplinary approach is needed to understand the fundamental neural mechanism of OUD. How does the brain of an OUD patient functionally and cognitively differ from others? This brief review is to compare and contrast the current literature on non-invasive resting state neuroimaging and clinical neuropsychological studies with the focus on the abstinence stage in OUD. The results show as follow: Brain connectivity strength in the reward system, dysregulation of circuits associated with emotion and stress, enhanced beta and alpha power activity, and high impulsivity are induced by OUD.Some recovery signs in cognition are demonstrated in OUD subjects after prolonged abstinence, but not in the subjects undergoing methadone treatment.Normalization in the composition of brain oscillations especially in the temporal region is induced and restored by methadone treatment in roughly 6 months in mean duration for OUDs having a mean opioid-use history of 10 years.We hope that the review provides valuable implications for clinical research and practice and paves a new insight into the future path to the identification of potential biomarkers and clinical outcome predictors in OUD in the domains of brain regions, functions, and behaviors.

Can neuroimaging help combat the opioid epidemic? A systematic review of clinical and pharmacological challenge fMRI studies with recommendations for future research

“…Despite this potential, effective translation of research findings into the clinical realm remains elusive [35]. To synthesize existing knowledge and facilitate effective translation of findings to real-world clinical settings, we aim to build upon recent reviews focused more broadly on fMRI findings across different substance use disorders [36,37] and others focused more narrowly on resting-state fMRI in OUD [38][39][40] by examining published fMRI literature (both task-based and resting-state) relevant to OUD, with an emphasis on findings related to opioid medications and treatment outcomes, as well as proposing areas for further research. By delineating common and distinct neural mechanisms of OUD pathophysiology and treatment response, it may be possible to identify which individuals are most likely to benefit from different treatments, optimize existing therapeutic approaches to target neural and clinical features of OUD, and unveil novel neuroscience-informed interventions to combat the nationwide opioid epidemic [32,35,41].…”

The Negative Affect of Protracted Opioid Abstinence: Progress and Perspectives From Rodent Models

“…In the future, it may be critical to investigate the negative affect induced by long-term oxycodone withdrawal, the most commonly overprescribed opioid in North America. Note that beyond negative affect, other long-term effects, such as cognitive alterations, are observed in humans (25) and detectable in rodents (53,54); however, these effects are beyond the scope of this review and have been investigated incompletely in animal research.…”

“…Human imaging studies investigating the opioid effects on the brain have been reviewed recently (23) and discussed (24) in the context of the 3-stage addiction cycle framework (5), showing in particular that negative affect during opioid withdrawal is associated with enhanced beta power activity and increased connectivity strength between the amygdala and ventral striatum-two main reward and aversion centers. In addition, human neuroimaging was performed under conditions of protracted opioid abstinence, and these studies have been reviewed previously (25). Notably, the opioid-abstinent human brain (at 2 weeks to 7 months of abstinence) shows alterations of functional connectivity strength between brain networks responsible for cognitive control, reward, and stress (26)(27)(28)(29).…”

Expert Consensus on Screening and Assessment of Cognition in Psychiatry

“…The anticognitive effects of alcohol consumption are well known and need to be assessed on a personalized basis, as is the case for opiate use. 52 Moreover, the careful review of substance use is required, as multiple substances that are misused are highly associated with impaired cognitive functions (methamphetamines, ketamine). 53,54 The high and rising rates of cannabis use across jurisdictions, fueled in part by changing legal, cultural, social, and political factors, is resulting in a larger number of individuals reporting cannabis consumption during the past year.…”