Salivary measurement and mindfulness-based modulation of prescription opioid cue-reactivity

• Published in: Drug and alcohol dependence 2020-12, Vol.217, p.108351-108351, Article 108351
• Main Authors: Hanley, Adam W., Garland, Eric L.
• Format: Article
• Language: English
• Subjects: Active control; Adult; Analgesics, Opioid - metabolism; Analgesics, Opioid - therapeutic use; Behavior modification; Body fluids; Chronic pain; Chronic Pain - drug therapy; Conditioning, Classical; Craving; Craving - drug effects; Cue exposure; Cue-reactivity; Cues; Dosage; Drugs; Exposure; Female; Health care; Humans; Intensive care; Intensive treatment; Intervention; Male; Measurement; Middle Aged; Mindfulness; Mindfulness-Oriented Recovery Enhancement; Narcotics; Opioid misuse; Opioid-Related Disorders - drug therapy; Opioids; Pain; Pilot Projects; Precision medicine; Prescription Drugs - therapeutic use; Prescriptions; Prevention programs; Primary care; Psychophysiology; Reactivity; Reinforcement; Reinforcement schedules; Saliva - metabolism; Schedules; Vulnerability
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2020.108351

•Chronic pain patients on long-term opioid therapy (LTOT) showed opioid cue-reactivity.•Patients salivated more in response to their opioid medication than a neutral object.•Patients reported greater craving in response to their medication than a neutral object.•Mindfulness training decreased salivation and craving when handling medication.•Salivation may serve as a useful, objective index of opioid cue-reactivity. Chronic pain patients on long-term opioid therapy (LTOT) may be at elevated risk for developing conditioned opioid cue-reactivity as their prescribed dosing schedules simultaneously function as fixed reinforcement schedules. Since opioids are typically consumed orally during LTOT, it stands to reason that opioid cue exposure might elicit conditioned salivary responses. However, no study has examined salivary cue-reactivity among opioid users during in-vivo exposure to their own prescription opioid medication. Two samples (N = 68, N = 39) of chronic pain patients on LTOT were recruited from primary care and specialty care clinics. Study 1 aimed to determine whether chronic pain patients receiving LTOT exhibited salivary cue-reactivity to their prescribed opioid. Study 2 was a pilot study that aimed to assess the effects of behavioral treatment on chronic pain patients’ salivary cue-reactivity. In Study 1, exposure to the patient’s own prescribed opioid resulted in significantly greater increases in salivation and cue-elicited craving than exposure to a neutral cue. In Study 2 participants who were randomized to an 8-week Mindfulness-Oriented Recovery Enhancement intervention evidenced significantly greater decreases in opioid cue-reactivity than participants in an active control condition as evidenced by both reduced salivation and craving ratings. Study findings demonstrate salivation may serve as a useful, objective index of opioid cue-reactivity. With further refinement of this task, conditioned salivary response could be used to identify especially vulnerable patients, who then could be targeted with a personalized medicine approach for selective and intensive prevention/treatment interventions to preempt escalation of opioid use to opioid misuse and OUD.