Which Drug Use Cues Play a Role in Prescription Opioid Dependence?

Researchers and addiction specialists are well aware that people affected by physical dependence and drug addiction commonly have a susceptibility to certain social and environmental cues that make ongoing substance use and relapses during substance treatment more likely. However, fairly little is known about the specific drug cues that motivate people physically dependent on prescription opioid medications. In a study published in August 2014 in the journal Addictive Behaviors, researchers from three U.S. institutions used controlled experiments to determine which types of cues tend to increase drug-using urges in individuals affected by prescription opioid dependence.

Prescription Opioid Dependence and Addiction

Prescription opioids are narcotic medications that doctors use to treat problems such as serious pain and serious, lingering coughs. A person who uses any one of these medications repeatedly over time, even in amounts prescribed by a doctor, can develop the symptoms of physical dependence when recurring opioid exposure produces ongoing changes in the chemical balance inside the brain’s pleasure center. For substances like alcohol with no specific usefulness as a medication, physical dependence and addiction are so closely linked that both terms can apply equally well to the same basic state of brain and behavioral dysfunction. However, prescription opioid users, in particular, can develop physical dependence without going on to experience addiction symptoms such as uncontrolled drug cravings, uncontrolled drug use and the establishment of a lifestyle that places a heavy emphasis on drug intake. Still, significant numbers of prescription opioid abusers do eventually transition from opioid dependence to full-blown opioid addiction.

Drug Cues

Substance users tend to drink, take drugs or take medications in specific circumstances rather than at random times and locations throughout the day. When substance use occurs repeatedly in a given set of circumstances, the mind starts to build up associations between those circumstances and the intake of the substance in question. In turn, when a situation previously associated with substance intake occurs, an individual can experience a conscious or unconscious increase in their desire to participate in substance use again. Experts in the field refer to situations and events that act as triggers for further substance use as drug cues. For any given person, these cues may appear internally as changes in feelings or thought processes, appear externally as changes in the surrounding environment, or (as is often the case) occur simultaneously both internally and externally.

Prescription Opioid Cues

In the study published in Addictive Behaviors, researchers from the Medical University of South Carolina, the U.S. Department of Veterans Affairs and the University of North Carolina used a small-scale experiment to determine which drug use cues can appear in people affected by prescription opioid dependence. These researchers did not specifically differentiate between opioid dependence and opioid addiction. All told, 37 people participated in the study; 20 of these participants had a dependence on an opioid medication, while 17 did not.

The researchers exposed the members of both groups to a number of experiences that might potentially serve as drug cues for prescription opioid use, including videos of people taking prescription opioids, videos of pharmacies and other locations with a potential link to prescription opioids, direct contact with pill bottles and other items commonly associated with prescription opioid intake and verbal statements about prescription opioids. As indications of an increased desire to use opioid medications after drug cue exposure, the researchers looked for things such as opioid cravings, a reduced ability to control opioid intake, increased tendencies toward angry outbursts, blood pressure increases, heart rate increases and increases in levels of the body’s main stress hormone (cortisol).

When the researchers compared the study participants affected by opioid dependence to the participants unaffected by dependence, they found that the opioid-dependent individuals experienced a range of notable changes after drug cue exposure, including heightened cravings for medication use, a declining control over medication intake, heart rate spikes and heightened stress and anger levels. Interestingly, both groups of study participants experienced blood pressure increases after exposure to the drug use cues.

The study’s authors expected to find some sort of connection between drug use cues and an increasing desire for medication intake in people affected by prescription opioid dependence. They believe their findings help identify precisely which types of cues have an effect on susceptible opioid medication users. In turn, they believe this knowledge may help guide the direction of research efforts conducted in the future and help improve the development of effective treatments for prescription opioid dependence.

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