Modulation of Attentional Bias to Drug and Affective Cues by Therapeutic and Neuropsychological Factors in Patients With Opioid Use Disorder on Methadone Maintenance Therapy

Objective: Abnormal selective attention to drug cues and negative affect is observed in patients with substance dependence, and it is closely associated with drug addiction and relapse. Methadone maintenance is an effective replacement therapy to treat heroin addiction, which significantly reduces the relapse rate. The present study examines whether the patients with opioid use disorder on chronic methadone maintenance therapy exhibit abnormal attentional bias to drug cues and negative-affective cues. Moreover, its relation to therapeutic and neuropsychological factors is also examined.Methods: Seventy-nine patients with opioid use disorder under chronic methadone maintenance therapy and 73 age-, sex-, and education-matched healthy controls were recruited and assessed for attentional bias to drug cues and negative affect using a dot-probe detection task. Correlational analysis was used to examine the relationships between the attentional bias and the demographic, therapeutic, and neuropsychological factors.Results: No significant overall patient-control group difference is observed in drug-related or negative-affective-related attentional bias scores. In the patient group, however, a significant negative correlation is found between the attentional bias scores to negative-affective cues and the duration of methadone treatment (p = 0.027), with the patients receiving longer methadone treatment showing less attentional avoidance to negative-affective cues. A significant positive correlation is found between the negative affect-induced bias and the impulsivity score (p = 0.006), with more impulsive patients showing higher attentional avoidance to negative affective cues than less impulsive patients. Additionally, the patients detect a smaller percentage of probe stimuli following the drug (p = 0.029) or negative-affective pictures (p = 0.009) than the healthy controls.Conclusion: The results of the present study indicate that the patients under chronic methadone maintenance therapy show normalized attentional bias to drug and negative-affective cues, confirming the involuntary attention of the patients is not abnormally captured by external drug or negative-affective clues. Our findings also highlight that the attentional avoidance of negative-affective cues is modulated by the duration of methadone treatment and the impulsivity level in the patients.

Laxatives and Erectile Dysfunction Medications to Treat Side Effects of Opioid Agonist and Methadone Maintenance Therapy

Opioid agonist and methadone maintenance therapies are essential medical interventions for effectively managing opioid use disorder. However, side effects, including constipation and erectile dysfunction can compromise treatment adherence and increase the risk of relapse. No studies or guidelines describing the clinical effectiveness or recommendations for the use of laxatives or erectile dysfunction medications in the treatment of constipation or erectile dysfunction in patients undergoing OAT or MMT were identified. Research is needed to understand the clinical effectiveness and inform guidance concerning the treatment of constipation with laxatives and the use of medications indicated for erectile dysfunction.

Comparing the Facial Emotion Recognition in Opioid Antecedent Subjects and Mixed Opioid-methamphetamine Antecedent Subjects under Methadone Maintenance Therapy with Control Group-A Retrospective Cohort Study

Background: Facial emotion recognition (FER) is an important social skill. Some studies have determined the capability of FER in substance abusers, but their results are contradictory. Objectives: This study aimed to investigate FER ability in opioid antecedent subjects and mixed opioid-methamphetamine antecedent subjects under methadone maintenance therapy compared to a control group. Methods: Following a retrospective cohort design, 71 methadone-maintained subjects (MMS) (40 individuals with a history of only opioid use disorder and 31 patients with a history of both opioid and methamphetamine use disorder) and 40 healthy participants filled the Persian version of Ackman and Friesen facial emotion experiment, which were matched based on age, education, and gender. Demographic and substance use characteristics were evaluated. Both groups were similar concerning the duration of the opioid use disorder, methadone maintenance treatment, and currently prescribed methadone dose. Data were analyzed using the chi-square, independent t-test, one-way ANOVA, and Welch test. Statistical significance was considered when P-value < 0.05. Results: Total FER scores were significantly lower in MMS compared to the control group. Concerning the subgroups, recognition of sadness was impaired in patients with a history of opioid use disorder (with and without a history of methamphetamine use disorder), while in recognition of anger and wonder, patients with both opioid and methamphetamine use disorder history had a significantly lower performance. There was no other significant difference between the groups. Conclusions: The findings suggest that social cognition deficit should be considered in strategies related to the addiction (both treatment and rehabilitation).

D4 and D5 dopamine receptor mRNA expression in human peripheral blood lymphocytes among cooccurring opioid and amphetamine-type stimulants use disorder undergoing methadone maintenance therapy

Introduction: Opioid and amphetamine type stimulant (ATS) exert their rewarding effects by stimulating the dopaminergic system in the mesolimbic area. It has been suggested that dopamine system in peripheral blood lymphocytes reflect the central dopamine system’s activity and pathology, especially in neuropsychiatric diseases including drug addiction. The present study aimed to assess the effect of co-occurring opioid and ATS (COATS) addiction towards mRNA expression of dopamine receptors DRD4 and DRD5 in peripheral blood lymphocytes (PBLs) of drug dependent subjects (n=36) undergoing methadone maintenance therapy in comparison to control subjects (n=36). Materials and methods: Ten mL blood were obtained from the subjects followed by lymphocyte isolation, RNA extraction and reverse transcription. DRD4 and DRD5 mRNA expression in peripheral lymphocytes was assessed using real-time PCR. The DRD4 mRNA expression but not DRD5 was significantly reduced in the peripheral lymphocytes of COATS subjects. Results: Mean expression value for DRD4 was 14.0+0.24 among patients and 13.3+0.25 among control subjects. For DRD5 it was 12.87 + 0.75 among patients and 12.59 + 1.24 among controls. Conclusion: Inconclusion, co-occurring opioid and ATS addiction was associated with persistent deficiency of DRD4 but not DRD5 in PBLs. Bangladesh Journal of Medical Science Vol.20(3) 2021 p.563-568