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Addiction Science & Clinical Practice
Published in: Addiction Science & Clinical Practice 1/2021

Open Access 01-12-2021 | Naloxone | Research

Neurocognitive, psychiatric, and substance use characteristics in a diverse sample of persons with OUD who are starting methadone or buprenorphine/naloxone in opioid treatment programs

Authors: Travis M. Scott, Julia Arnsten, James Patrick Olsen, Franchesca Arias, Chinazo O. Cunningham, Monica Rivera Mindt

Published in: Addiction Science & Clinical Practice | Issue 1/2021

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Abstract

Background

Medications for opioid use disorder such as opioid agonist treatment (OAT, including methadone, buprenorphine) are the gold standard intervention for opioid use disorder (OUD). Persons with OUD have high rates of neurocognitive impairment and psychiatric and substance use disorders, but few studies have examined these characteristics in diverse patients initiating OAT in opioid treatment programs (OTPs). Additionally, in these individuals, poor neurocognitive functioning and psychiatric/other substance use disorders are associated with poor OUD treatment outcomes. Given rapid changes in the opioid epidemic, we sought to replicate findings from our pilot study by examining these characteristics in a large diverse sample of persons with OUD starting OTP-based OAT.

Methods

Ninety-seven adults with OUD (M age = 42.2 years [SD = 10.3]; M education = 11.4 years [SD = 2.3]; 27% female; 22% non-Hispanic white) were enrolled in a randomized longitudinal trial evaluating methadone versus buprenorphine/naloxone on neurocognitive functioning. All participants completed a comprehensive neurocognitive, psychiatric, and substance use evaluation within one week of initiating OAT.

Results

Most of the sample met criteria for learning (79%) or memory (69%) impairment. Half exhibited symptoms of current depression, and comorbid substance use was highly prevalent. Lifetime cannabis and cocaine use disorders were associated with better neurocognitive functioning, while depression was associated with worse neurocognitive functioning.

Conclusions

Learning and memory impairment are highly prevalent in persons with OUD starting treatment with either methadone or buprenorphine/naloxone in OTPs. Depression and comorbid substance use are prevalent among these individuals, but neither impact learning or memory. However, depression is associated with neurocognitive impairment in other domains. These findings might allow clinicians to help persons with OUD starting OAT to develop compensatory strategies for learning and memory, while providing adjunctive treatment for depression.
Trial Registration NCT, NCT01733693. Registered November 4, 2012, https://​clinicaltrials.​gov/​ct2/​show/​NCT01733693.
Literature
1.
2.
Ducharme LJ, Abraham AJ. State policy influence on the early diffusion of buprenorphine in community treatment programs. Subst Abuse Treat Prev Policy. 2008;3(1):17.PubMedPubMedCentralCrossRef
3.
Domínguez-Salas S, Díaz-Batanero C, Lozano-Rojas OM, Verdejo-García A. Impact of general cognition and executive function deficits on addiction treatment outcomes: systematic review and discussion of neurocognitive pathways. Neurosci Biobehav Rev. 2016;71:772–801.PubMedCrossRef
4.
Passetti F, Clark L, Mehta MA, Joyce E, King M. Neuropsychological predictors of clinical outcome in opiate addiction. Drug Alcohol Depend. 2008;94(1–3):82–91.PubMedCrossRef
5.
Arias F, Arnsten JH, Cunningham CO, Coulehan K, Batchelder A, Brisbane M, et al. Neurocognitive, psychiatric, and substance use characteristics in opioid dependent adults. Addict Behav. 2016;60:137–43.PubMedPubMedCentralCrossRef
6.
Baldacchino A, Balfour DJK, Passetti F, Humphris G, Matthews K. Neuropsychological consequences of chronic opioid use: a quantitative review and meta-analysis. Neurosci Biobehav Rev. 2012;36(9):2056–68.PubMedCrossRef
7.
8.
Fernández-Serrano MJ, Pérez-García M, Verdejo-García A. What are the specific vs. generalized effects of drugs of abuse on neuropsychological performance? Neurosci Biobehav Rev. 2011;35(3):377–406.PubMedCrossRef
9.
Gruber SA, Silveri MM, Yurgelun-Todd DA. Neuropsychological consequences of opiate use. Neuropsychol Rev. 2007;17(3):299–315.PubMedCrossRef
10.
Lee TMC, Pau CWH. Impulse control differences between abstinent heroin users and matched controls. Brain Inj. 2002;16(10):885–9.PubMedCrossRef
11.
Verdejo-Garcia A, Perez-Garcia M. Profile of executive deficits in cocaine and heroin polysubstance users: common and differential effects on separate executive components. Psychopharmacology. 2007;190(4):517–30.PubMedCrossRef
12.
13.
14.
Mintzer MZ, Correia CJ, Strain EC. A dose-effect study of repeated administration of buprenorphine/naloxone on performance in opioid-dependent volunteers. Drug Alcohol Depend. 2004;74(2):205–9.PubMedCrossRef
15.
Betts KS, Chan G, McIlwraith F, Dietze P, Whittaker E, Burns L, et al. Differences in polysubstance use patterns and drug-related outcomes between people who inject drugs receiving and not receiving opioid substitution therapies. Addiction. 2016;111(7):1214–23.PubMedCrossRef
16.
Havard A, Teesson M, Darke S, Ross J. Depression among heroin users: 12-Month outcomes from the Australian Treatment Outcome Study (ATOS). J Subst Abuse Treat. 2006;30(4):355–62.PubMedCrossRef
17.
Goldner EM, Lusted A, Roerecke M, Rehm J, Fischer B. Prevalence of Axis-1 psychiatric (with focus on depression and anxiety) disorder and symptomatology among non-medical prescription opioid users in substance use treatment: systematic review and meta-analyses. Addict Behav. 2014;39(3):520–31.PubMedCrossRef
18.
Agrawal A, Lynskey MT, Madden PAF, Bucholz KK, Heath AC. A latent class analysis of illicit drug abuse/dependence: results from the national epidemiological survey on alcohol and related conditions. Addiction. 2006;102(1):94–104.CrossRef
19.
Krausz M, Degkwitz P, Kühne A, Verthein U. Comorbidity of opiate dependence and mental disorders. Addict Behav. 1998;23(6):767–83.PubMedCrossRef
20.
Griffin ML, Dodd DR, Potter JS, Rice LS, Dickinson W, Sparenborg S, et al. Baseline characteristics and treatment outcomes in prescription opioid dependent patients with and without co-occurring psychiatric disorder. Am J Drug Alcohol Abuse. 2014;40(2):157–62.PubMedCrossRef
21.
O’Donnell JK, Halpin J, Mattson CL, Goldberger BA, Gladden RM. Deaths involving fentanyl, fentanyl analogs, and U-47700-10 states, July–December 2016. MMWR Morb Mortal Wkly Rep. 2017;66(43):1197–202.PubMedPubMedCentralCrossRef
22.
Loeber S, Nakovics H, Kniest A, Kiefer F, Mann K, Croissant B. Factors affecting cognitive function of opiate-dependent patients. Drug Alcohol Depend. 2012;120(1–3):81–7.PubMedCrossRef
23.
Wilkinson GS. Wide range achievement test 3—administration manual. Wilimington: Jastak Associates Inc; 1993.
24.
Strauss E, Sherman EMS, Spreen O. A compendium of neuropsychological tests: administration, norms, and commentary. Washington: American Chemical Society; 2006.
25.
Benedict RHB, Schretlen D, Groninger L, Dobraski M, Shpritz B. Revision of the brief visuospatial memory test: studies of normal performance, reliability, and validity. Psychol Assess. 1996;8(2):145–53.CrossRef
26.
Benedict RHB, Schretlen D, Groninger L, Brandt J. Hopkins Verbal Learning Test–revised: normative data and analysis of inter-form and test-retest reliability. Clin Neuropsychol. 1998;12(1):43–55.CrossRef
27.
Diehr MC, Cherner M, Wolfson TJ, Miller SW, Grant I, Heaton RK. The 50 and 100-item short forms of the Paced Auditory Serial Addition Task (PASAT): demographically corrected norms and comparisons with the full PASAT in normal and clinical samples. J Clin Exp Neuropsychol. 2003;25(4):571–85.PubMedCrossRef
28.
Heaton RK, Miller SW, Taylor MJ, Grant I. Revised comprehensive norms for an expanded Halstead-Reitan battery: demographically adjusted neuropsychological norms for African American and Caucasian adults. Lutz: Psychological Assessment Resources; 2004.
29.
Kongs SK, Thompson LL, Iverson GL, Heaton RK. Wisconsin card sorting test-64 card version professional manual. Odessa: Psychological Assessment Resources; 2000.
30.
Wechsler D. Advanced clinical solutions for the WAIS-IV and WMS-IV. San Antonio: Pearson; 2008.
31.
Woods SP, Rippeth JD, Frol AB, Levy JK, Ryan E, Soukup VM, et al. Interrater reliability of clinical ratings and neurocognitive diagnoses in HIV. J Clin Exp Neuropsychol. 2004;26(6):759–78.PubMedCrossRef
32.
Beck AT, Steer RA, Brown GK. Beck depression inventory-II. San Antonio: Psychological Corporation; 1996.
33.
World Health Organization. CIDI-Auto Version 2.1: administrator’s guide and reference. Sydney: Training and reference centre for WHO CIDI; 1997.
34.
McLellan AT, Kushner H, Metzger D, Peters R, Smith I, Grissom G, et al. The fifth edition of the Addiction Severity Index. J Subst Abuse Treat. 1992;9(3):199–213.PubMedCrossRef
35.
SPSS. IBM SPSS Statistics Version 21. Boston: Mass Int Bus Mach Corp; 2012.
36.
Darke S, Ross J. Polydrug dependence and psychiatric comorbidity among heroin injectors. Drug Alcohol Depend. 1997;48(2):135–41.PubMedCrossRef
37.
Eisch AJ, Harburg GC. Opiates, psychostimulants, and adult hippocampal neurogenesis: insights for addiction and stem cell biology. Hippocampus. 2006;16(3):271–86.PubMedCrossRef
38.
Lyoo IK, Pollack MH, Silveri MM, Kyung HA, Diaz CI, Hwang J, et al. Prefrontal and temporal gray matter density decreases in opiate dependence. Psychopharmacology. 2006;184(2):139–44.PubMedCrossRef
39.
40.
Gruber SA, Sagar KA, Dahlgren MK, Racine MT, Smith RT, Lukas SE. Splendor in the grass? A pilot study assessing the impact of medical marijuana on executive function. Front Pharmacol. 2016;7:355.PubMedPubMedCentralCrossRef
41.
Crean RD, Crane NA, Mason BJ. An evidence based review of acute and long-term effects of cannabis use on executive cognitive functions. J Addict Med. 2011;5(1):1.PubMedPubMedCentralCrossRef
42.
Gruber SA, Tzilos GK, Silveri MM, Pollack M, Renshaw PF, Kaufman MJ, et al. Methadone maintenance improves cognitive performance after two months of treatment. Exp Clin Psychopharmacol. 2006;14(2):157–64.PubMedCrossRef
43.
Rapeli P, Fabritius C, Alho H, Salaspuro M, Wahlbeck K, Kalska H. Methadone vs. buprenorphine/naloxone during early opioid substitution treatment: a naturalistic comparison of cognitive performance relative to healthy controls. BMC Clin Pharmacol. 2007;7:5.PubMedPubMedCentralCrossRef
44.
Jones CM, Logan J, Gladden RM, Bohm MK. Vital signs: demographic and substance use trends among heroin users—United States, 2002–2013. MMWR Morb Mortal Wkly Rep. 2015;64(26):1–7.
45.
Substance Abuse and Mental Health Services Administration. Treatment Episode Data Set (TEDS): 2004–2014. Rockville: National admissions to substance abuse treatment services; 2016.
Metadata
Title
Neurocognitive, psychiatric, and substance use characteristics in a diverse sample of persons with OUD who are starting methadone or buprenorphine/naloxone in opioid treatment programs
Authors
Travis M. Scott
Julia Arnsten
James Patrick Olsen
Franchesca Arias
Chinazo O. Cunningham
Monica Rivera Mindt
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Addiction Science & Clinical Practice / Issue 1/2021
Electronic ISSN: 1940-0640
DOI
https://doi.org/10.1186/s13722-021-00272-4

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