Opioid use disorder (OUD) accounts for 70% of the global disease burden attributable to drug use disorder, affects ~2 million American adults, and is the leading reason for receipt of drug treatment. Pharmacotherapies for OUD (RxOUD) are essential first-line treatment options that markedly facilitate recovery, and include the opioid agonist treatments (OAT) methadone (MET) and buprenorphine (BUP). Fortunately, government efforts have greatly expanded access to these lifesaving treatments. As OUD and OAT rates rise, characterization of the patients undergoing these treatments and the factors influencing their recovery is crucial. Neurological abnormalities are one of the most prevalent classes of secondary disease in OUD. Neurocognitive dysfunction is linked to poorer recovery outcomes and OUD-related deficits span a broad range of cognitive domains. Evidence indicates improvement with remission. Yet, the cognitive trajectories of BUP and MET treated OUD patients are largely unknown. Given the cognitive deficits accompanying OUD and OAT, and the role of cognition in addiction recovery, characterizing neurocognition during OAT and its relationship to OUD recovery has clinically relevant implications. This area of study can ultimately inform novel therapeutic approaches for enhancing OUD treatment and recovery. As a first step in this line of work, this prospective study seeks to enhance our understanding of cognitive change during OAT and its relationship to multifaceted measures of recovery (quality of life and opioid use frequency) in an ecologically valid sample of BUP and MET patients. This 3-year mentored project aims (1) to determine if cognition improves, declines, or remains static after 6 weeks of OAT, and whether these cognitive trajectories are specific to cognitive domain or OAT group, (2) to investigate whether cognitive trajectories predict 10-week recovery outcomes, and evaluate the influence of group and treatment-relevant measures on cognition-recovery relationships. The ultimate goal of this line of work is to assess RxOUD-specific and OUD-general cognitive trajectories, their neural substrates, and recovery outcomes via prospective controlled investigation. Accordingly, this study also aims (3) to demonstrate the feasibility of developing a similar but more comprehensive study. In addition to contributing to a limited literature, this project can ultimately provide an important foundation for future research and inform the development of cognitive rehabilitation treatments that complement RxOUD and enhance recovery outcomes. The scientific aims support training in 3 competency areas: (1) treatment/recovery research, (2) longitudinal design and implementation, and (3) OUD. Training will be fulfilled with the expert guidance of Drs. John Kelly (sponsor), Bettina Hoeppner (co-sponsor), Roger Weiss and Randi Schuster (consultants). The training and experience provided by this award will serve as a critical foundation from which to build a research program that will help inform one of the most substantial public health crises in modern times.
Opioid agonist therapies are essential first-line treatments for opioid use disorder, but we know very little about their neurocognitive correlates during recovery. Given that cognitive impairment accompanies opioid use disorder, hinders recovery, and has the potential to improve, it is essential to gain a better understanding of neurocognitive function during opioid agonist therapy. As a first step in this line of work, the current project will investigate cognitive change during agonist treatment and its relationship to recovery outcomes in an ecologically valid sample of opioid use disorder patients, which can ultimately inform the development of cognitive rehabilitation treatments that complement agonist therapy and enhance recovery outcomes.
