Simulated opioid choice linked to opioid use disorder severity among veterans with chronic pain: initial validation of a novel paradigm

ABSTRACT

Background: Modeling addictive behavior among individuals with, or at risk for, opioid use disorder (OUD) in a way that is accurate, ethical, and reproducible presents a pressing concern. OUD risk is elevated among people with chronic pain on long-term opioid therapy (LTOT).

Objectives: To provide initial validation of a novel opioid preference task as an index of OUD and its symptomatology among veterans prescribed opioids for chronic pain, a population at high risk for poor opioid-related outcomes. The relative ease by which such a paradigm can be implemented and performed in clinical contexts, including enabling investigation of opioid reinforcement and drug-seeking behavior while avoiding ethical pitfalls associated with direct drug administration, could make this task an attractive approach for potentially tracking OUD symptoms.

Methods: We studied 87 veterans (74 males, 13 females) on LTOT for chronic pain – 33 of whom had OUD diagnoses. Participants completed a picture-viewing choice task to assess preference for viewing opioid-related images in comparison with standardized pleasant, unpleasant, neutral, and blank images. Opioid-related choice, measured by vigor of button pressing, was tested for association with OUD severity (measured by symptom counts), as well as craving and anhedonia.

Results: Choice for opioid-related images was positively correlated with OUD severity (i.e., number of DSM-5 measured OUD symptoms) (r = 0.38, p < .001), particularly among those meeting diagnostic criteria for OUD (r = 0.47, p = .006). Neither craving nor anhedonia correlated with opioid-related choice.

Conclusions: Our results provide initial validation for a new opioid picture-choice paradigm in patients with chronic pain.

KEYWORDS:

• Opioid use disorder
• drug choice
• chronic pain
• craving
• anhedonia

Disclosure statement

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

Additional information

Funding

This study was supported by W81XWH-16-1-0522 from the U.S. Department of Defense (PI: ELG), and R01DA042033 and R01DA048094 from the National Institute on Drug Abuse (PI: ELG). Further support came from the National Institute on Drug Abuse [R01DA051420 and R01DA049733 to SJM]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Defense or National Institutes of Health.