How Does Drug Craving Manifest in People Addicted to Prescription Opioids?

Drug cravings are prominent urges to consume more of a mind-altering drug or medication. The presence of these urges is one of the symptoms that doctors look for when diagnosing various forms of substance use disorder (substance abuse/substance addiction). In a study published in September/October 2014 in The American Journal on Addictions, a team of Harvard-affiliated researchers explored the ways in which drug cravings manifest in people affected by an addiction to prescription opioids. These researchers also compared the drug cravings associated with prescription opioid addiction to the cravings associated with heroin addiction.

Drug Cravings

Drug addiction alters the basic chemical environment inside the brain’s pleasure center; specifically, it creates long-term changes in the levels of the pleasure-producing brain chemical called dopamine. Once this altered dopamine level is established, the brain starts to rely on the continued presence of the drug in question in order to maintain its “normal” function. Cravings act as recurring reminders that the brain must have its drug needs met. When an addicted person’s intake level falls off for even short amounts of time, these urges appear and reinforce the habitual, involuntary routine of substance use. In addition to the brain’s functional needs, drug cravings are associated with internal and environmental reinforcers of drug-using behavior commonly known as drug cues. Essentially, a drug cue consciously or unconsciously ramps up the urge to consume more of a given substance, and thereby helps make sure than an addicted individual meets the basic chemical requirements of his or her addiction. Potential types of drug cues active for any given person include the physical settings where drug use has occurred in the past, the presence of other people previously associated with drug use, the presence of mental states that triggered drug use in the past and the presence of trains of thought previously associated with drug use. The emergence of drug cues and drug cravings during substance treatment puts all recovering addicts at-risk for the onset of a drug relapse.

Prescription Opioids & Addiction

Prescription opioids are employed by doctors for purposes that include the relief of moderate or severe pain symptoms and the suppression of severe coughing and other cold or allergy symptoms that don’t respond to more conservative treatment. Like heroin and other illegal/illicit opioid drugs, these medications are easily capable of producing the long-term brain changes responsible for triggering the onset of drug addiction. In the U.S., common sources of prescription opioid addiction include medications that contain a substance called oxycodone (e.g., OxyContin, Percocet and Percodan) and medications that contain a substance called hydrocodone (e.g., Vicodin, Lorcet and Lortab).

How Does Craving Manifest?

In the study published in The American Journal on Addictions, researchers from McLean Hospital and Harvard Medical School used a project involving 50 opioid-addicted adults to explore the ways in which drug craving appears in people affected by prescription opioid addiction. Twenty of the study participants were addicted to an opioid medication, while 25 had an addiction to heroin. The remaining five participants used both prescription opioids and heroin or some other illegal/illicit opioid drug. The researchers included the heroin users in the study pool in order to compare the manifestation of drug cravings in prescription opioid addiction to its manifestation in heroin addiction. The researchers exposed all of the study participants to a total of 90 images. Some of these images were designed as drug cues for prescription opioid intake, while others were designed as drug cues for heroin intake. A third subset of images contained no cues for prescription or heroin use. After comparing the responses to the images, the researchers concluded that people addicted to prescription opioids and people addicted to heroin both are both sensitive to the craving-related effects of drug cues. They also concluded that prescription opioid addicts feel lower levels of craving when exposed to opioid medication-related cues than heroin addicts feel when exposed to heroin-related cues. However, further analysis revealed the differences in opioid craving levels between the two groups to be small and statistically insignificant. The study’s authors undertook their efforts, in part, because very few researchers have specifically focused on the importance of drug cravings in people affected by prescription opioid addiction. They believe that their findings indicate the relevance of these cravings in prescription opioid-addicted individuals. They also believe that improved awareness of the importance of drug cravings in this population will help improve the quality of treatment provided in opioid-focused substance programs. By: Gideon Hoyle

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