Childhood-Onset Attention-Deficit/Hyperactivity Disorder Exacerbates Opioid Use Disorder Consequences: Mediation by Impulsive Phenotypes

Background: Attention deficit hyperactivity disorder (ADHD) is highly prevalent and associated with opioid use disorder (OUD). Yet, little is known about the mechanisms by which ADHD (which is a heterogeneous construct/diagnosis) might alter the trajectory of OUD outcomes. Aim: This cross-sectional study examines relationships between childhood ADHD (inferred as predating substance use) and the extent to which the effects of ADHD on lifetime heroin-use consequences are mediated by foreshortened time perspective and drug-use impulsivity. Methods: Individuals who report heroin use (N=214) were screened using the Assessment of Hyperactivity and Attention (AHA), Impulsive Relapse Questionnaire (IRQ), Stanford Time Perception Inventory (STPI), and a comprehensive assessment of lifetime and current substance use and substance-related consequences. Results: Relative to participants whose AHA scores did not meet criteria for lifetime ADHD diagnosis (n=88), those with persistent ADHD (childhood and adult, n=62) endorsed significantly more total lifetime heroin-use consequences despite comparable heroin-use severity. Likewise, there was a significant indirect effect of the combined ADHD subtype in childhood on lifetime heroin-use consequences. This effect was mediated by STPI scores indicating less future (and more hedonism in the present) temporal perspective and by IRQ scores indicating less capacity for delaying drug use. Conclusion: The combined ADHD subtype in childhood is significantly associated with lifetime heroin-use consequences, and this effect is mediated through higher drug-use impulsivity (less capacity for delay) and lower future temporal perspective. Keywords: ADHD; heroin; opioid use disorder; impulsivity; time perspectiv

A virtual reality martial arts-based intervention reduces pain, drug craving, and stress in patients with opioid use disorder

Background: Some individuals with opioid use disorder (OUD) report high levels of pain, anxiety, stress and drug craving that may occasion relapse, reduce adherence to treatment, and reduce quality of life. This pilot study evaluated whether a novel martial arts-based intervention can lower self-reported and physiological markers of pain, anxiety, stress and opioid craving in individuals with OUD undergoing methadone maintenance treatment (MMT). Methods: 15 MMT patients (11 females) completed a 12-week ‘Heroes Circle’ intervention that involved twice-weekly 30-min sessions centering around martial arts-based breathing and meditative techniques using therapist-assisted virtual reality (VR). Patients self-reported on five measures (pain, drug craving, anxiety, depression, anger) using a 0-10 scale before (pre) and after (post) each session. Salivary markers of inflammation (C-reactive protein [CRP]) and stress (cortisol) were collected before and after several sessions (baseline, weeks 4, 8, and 12). Results: There were significant pre-post session reductions in rated pain, drug craving, anxiety and depression, and saliva cortisol (ps\u3c0.05). For opioid craving, there was also an effect of week such that craving decreased from weeks 1-6, increased from 7-9, and decreased again from 10-12 (ps\u3c0.05); there was also a session x week interaction such that the pre-post reduction in craving reached significance in weeks 1-3 only. There were no significant main effects or interactions for anger or CRP (ps\u3e0.05). Conclusions: These preliminary results suggest VR-based, martial-arts meditative intervention is a promising approach for reducing pain, anxiety, stress and craving levels among individuals with OUD. Further controlled studies are warranted

A novel martial arts-based virtuality reality intervention modulates pain and the pain neuromatrix in patients with opioid use disorder

Background: Standard-of-care for opioid use disorder (OUD) includes medication and counseling. However, there is an unmet need for complementary approaches to treat OUD patients coping with pain; furthermore, few studies have probed neurobiological features of pain or its management during OUD treatment. This preliminary study examines neurobiological and behavioral effects of a martial arts-based intervention in patients undergoing methadone maintenance treatment (MMT). Methods: Fifteen (11 female) MMT patients completed a virtual reality, therapist-guided martial arts intervention that included breathing and relaxation exercises; sessions were scheduled twice weekly. Assessments included functional magnetic resonance imaging (fMRI) of pain neuromatrix activation and connectivity (pre- and post-intervention), saliva cortisol and C-reactive protein (CRP) at baseline and weeks 4, 8 and 12; and self-reported pain and affective symptoms before and after each intervention session. Results: After each intervention session (relative to pre-session), ratings of pain, opioid craving, anxiety and depression (but not anger) decreased. Saliva cortisol (but not CRP) levels decreased from pre- to post-session. From pre- to post-intervention fMRI assessments, pain task-related left postcentral gyrus (PCG) activation decreased. Higher baseline cortisol levels were associated with greater post-intervention pain task-related insular activation. At baseline, PCG showed positive connectivity with other regions of the pain neuromatrix, but this pattern changed post-intervention. Conclusions: These preliminary findings demonstrate feasibility, therapeutic promise, and brain basis of a martial arts-based intervention for OUD patients undergoing MMT

Effects of Cocaine and/or Heroin Use on Resting Cardiovascular Function

Background: Regular cocaine and/or heroin use is associated with major health risks, especially cardiovascular disease (CVD), but confounded by other factors. Objectives: We examined effects of chronic (years of regular use) and recent (past-month) use of cocaine and heroin, controlling for other factors, on resting cardiovascular function. Methods: In a sample of cocaine and/or heroin users (N=292), we obtained data on demographics, body mass index (BMI), history of substance use, and electrocardiogram, heart rate (HR) and blood pressure (BP). Following bivariate correlations, three-block (1: demographics, BMI; 2: tobacco, alcohol, marijuana; 3: cocaine, heroin) regression analyses were conducted to predict cardiovascular measures. Results: Higher BMI predicted increased systolic and diastolic BP (as did older age), increased supine HR, and longer QRS duration, QTc interval, PR interval, and P-wave duration. Recent substance use had more reliable effects than chronic use on cardiovascular measures. Past-month marijuana-use days predicted higher systolic BP, lower supine HR, and greater likelihood of early repolarization and ST elevation, whereas average daily marijuana use predicted shorter QTc interval. Average daily alcohol use predicted higher diastolic BP, higher supine HR and lower likelihood of sinus bradycardia (HRbpm). Past-month tobacco-use days predicted shorter QTc interval and increased likelihood of profound bradycardia (HRbpm). Past-month heroin-use days predicted lower seated HR, greater likelihood of sinus bradycardia and lower likelihood of left ventricular hypertrophy. More years of regular cocaine use and past-month cocaine-use days predicted longer QTc interval. Conclusions: Cocaine and heroin incrementally predicted modest variance in resting bradycardia and QTc interval. Clinicians should first consider demographics and recent use of tobacco, alcohol and marijuana before assuming cocaine and heroin affect these measures