Social and cognitive determinants of medications for opioid use disorder outcomes: A systematic review using a social determinants of health framework

Abstract

Disparities exist in the engagement and success of individuals seeking medications for opioid use disorder (MOUD) treatment. Existing work suggests that individual-level factors such as cognitive functioning influence MOUD treatment, less is known about the role of environmental factors beyond the individual such as social determinants of health (SDOH). The aim of this systematic review was to summarize the literature of neuropsychological assessment in the context of MOUD treatment using an SDOH framework. We included peer-reviewed articles based in the United States and published in the English language that evaluated neuropsychological assessment on MOUD treatment outcomes. Three electronic databases were searched from January 2022 to September 2023 without restricting the date of publication for article inclusion. We identified 34 empirical articles that met inclusion criteria, the majority being nonrandomized clinical trials. Few studies examined differences in neuropsychological performance over time or in response to an adjunct intervention. Findings comparing cognitive functioning across MOUD and comparisons groups were mixed, as were findings from the studies that examined changes in cognitive functioning over time. Factors represented from the SDOH framework included educational attainment, premorbid intellectual functioning, and employment status. Neuropsychological domains and type of assessments varied, as did inclusion/exclusion and demographic characteristics. Existing literature is mixed on whether neuropsychological deficits in individuals with OUD are amenable to treatment, particularly among populations disproportionally disadvantaged by SDOH. More research is needed on the SDOH and other contextual factors that influence cognitive factors and MOUD treatment engagement and success.

Keywords:

• Medications for opioid use disorder
• neuropsychological assessment
• social determinants of health

Authors’ contributions

All authors contributed to the study conception and design. Material preparation, data collection, and data analysis were performed by Alexandra Hernandez-Vallant and Margo C. Hurlocker. The first draft of the manuscript was written by Alexandra Hernandez-Vallant, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Availability of data and materials

Data extracted in the proposed systematic review is available upon request.

Code availability

Codebook of data extracted in the proposed systematic review is available upon request.

Ethics approval

This study is a systematic review that used the PRISMA guidelines. No ethical approval is required.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Institute of Alcohol Abuse and Alcoholism (NIAAA) under grant T32AA018108 (PI: Witkiewitz) on National Institute on Drug Abuse (NIDA) under grant K23DA052646 (PI: Hurlocker).