Although opioid dependent persons who begin opioid agonist treatment (OAT) significantly reduce their risk of health problems and improve their quality of life, relapse rates are high. Models of opioid relapse involve biological, motivational, cognitive, and behavioral factors. While some factors, such as genetic predisposition are directly observable, other known risks for relapse such as subjective craving and behavioral impulsivity are often indirectly measured using self-report questionnaires and behavioral observations. We propose to examine predictors of opioid lapse and relapse outcomes by directly measuring neural activity associated with impulsive decision-making about reward (DD), working memory (WM) and working memory cognitive persistence (WMCP), and craving (CR) using functional magnetic resonance imaging (FMRI) in 72 opioid- dependent individuals who are initiating buprenorphine therapy. Participants will be assessed twice using FMRI, first while stably using their illicit opioid and again 3-5 days later in opioid withdrawal, both scans prior to buprenorphine initiation. Follow-up contacts over twelve weeks will determine outcome group assignment (early lapse/no early lapse, relapse/no relapse). Early opioid lapses are common, particularly during the first week of buprenorphine, and have been strongly related to full relapse. Relapse will be defined as buprenorphine termination (treatment drop-out). In addition to targeted FMRI analyses of brain response to DD, WM, WMCP and CR challenges, we will employ novel FMRI methods to assess coherence of neural network functions and compensatory neural mechanisms that have not yet been used to study early lapse and relapse risk. This is the first study of neuroimaging predictors of relapse in opioid dependent persons and novel imaging markers may facilitate identification of opioid users at greater risk for lapse and relapse, improve our understanding of the neurocognitive mechanisms of relapse, and suggest targets for behavioral and pharmacologic interventions in future clinical studies.
Opioid dependent persons who initiate buprenorphine treatment to quit illicit opioid use significantly reduce their risk of life-threatening health prolems and improve their quality of life, yet risk of treatment drop-out and relapse is high. We will determine if the addition of pre-treatment FMRI assessments provide more sensitive markers of relapse than traditional methods, providing a greater understanding of how neurocognitive and neurobehavioral treatments may act at the level of the brain to forestall relapse.
