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. 2020 Dec 1:217:108351.
doi: 10.1016/j.drugalcdep.2020.108351. Epub 2020 Oct 12.

Salivary measurement and mindfulness-based modulation of prescription opioid cue-reactivity

Adam W Hanley  1 , Eric L Garland  2
Affiliations

Salivary measurement and mindfulness-based modulation of prescription opioid cue-reactivity

Adam W Hanley et al. Drug Alcohol Depend. .

Abstract

Background: Chronic pain patients on long-term opioid therapy (LTOT) may be at elevated risk for developing conditioned opioid cue-reactivity as their prescribed dosing schedules simultaneously function as fixed reinforcement schedules. Since opioids are typically consumed orally during LTOT, it stands to reason that opioid cue exposure might elicit conditioned salivary responses. However, no study has examined salivary cue-reactivity among opioid users during in-vivo exposure to their own prescription opioid medication.

Methods: Two samples (N = 68, N = 39) of chronic pain patients on LTOT were recruited from primary care and specialty care clinics. Study 1 aimed to determine whether chronic pain patients receiving LTOT exhibited salivary cue-reactivity to their prescribed opioid. Study 2 was a pilot study that aimed to assess the effects of behavioral treatment on chronic pain patients' salivary cue-reactivity.

Results: In Study 1, exposure to the patient's own prescribed opioid resulted in significantly greater increases in salivation and cue-elicited craving than exposure to a neutral cue. In Study 2 participants who were randomized to an 8-week Mindfulness-Oriented Recovery Enhancement intervention evidenced significantly greater decreases in opioid cue-reactivity than participants in an active control condition as evidenced by both reduced salivation and craving ratings.

Conclusions: Study findings demonstrate salivation may serve as a useful, objective index of opioid cue-reactivity. With further refinement of this task, conditioned salivary response could be used to identify especially vulnerable patients, who then could be targeted with a personalized medicine approach for selective and intensive prevention/treatment interventions to preempt escalation of opioid use to opioid misuse and OUD.

Keywords: Chronic pain; Craving; Cue-reactivity; Mindfulness-Oriented Recovery Enhancement; Opioid misuse; Psychophysiology.

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Conflict of interest statement

Conflict of Interest: Eric Garland, PhD, LCSW is the Director of the Center on Mindfulness and Integrative Health Intervention Development. The Center provides Mindfulness-Oriented Recovery Enhancement (MORE), mindfulness-based therapy, and cognitive behavioral therapy in the context of research trials for no cost to research participants; however, Dr. Garland has received honoraria and payment for delivering seminars, lectures, and teaching engagements (related to training clinicians in mindfulness) sponsored by institutions of higher education, government agencies, academic teaching hospitals, and medical centers. Dr. Garland receives royalties from the sale of books related to MORE. Dr. Garland also is a consultant to BehaVR, LLC.

Conflict of Interest: No conflict declared.

Conflict of interest disclosure. Eric Garland is the Director of the Center on Mindfulness and Integrative Health Intervention Development. The Center provides mindfulness-based therapy in the context of research trials for no cost to research participants; however, Dr. Garland has received honoraria and payment for delivering seminars, lectures, and teaching engagements (related to training clinicians in Mindfulness-Oriented Recovery Enhancement) sponsored by institutions of higher education, government agencies, academic teaching hospitals, and medical centers. Dr. Garland is also a consultant for BehaVR.

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