Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-18T22:07:57.503Z Has data issue: false hasContentIssue false
  • English
  • Français

Impulsivity and opioid drugs: differential effects of heroin, methadone and prescribed analgesic medication

Published online by Cambridge University Press:  28 August 2014

A. Baldacchino ,
D. J. K. Balfour  and
K. Matthews
A. Baldacchino*
Affiliation:
Division of Neuroscience, Medical Research Institute, Ninewells Hospital and Medical School, Dundee University, Dundee, UK.
D. J. K. Balfour
Affiliation:
Division of Neuroscience, Medical Research Institute, Ninewells Hospital and Medical School, Dundee University, Dundee, UK.
K. Matthews
Affiliation:
Division of Neuroscience, Medical Research Institute, Ninewells Hospital and Medical School, Dundee University, Dundee, UK.
*
*Author for correspondence: A. Baldacchino, Ph.D., Division of Neuroscience, Medical Research Institute, Ninewells Hospital and Medical School, Dundee University, Dundee, DD1 9SY, UK. (Email: a.baldacchino@dundee.ac.uk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

Previous studies have provided inconsistent evidence that chronic exposure to opioid drugs, including heroin and methadone, may be associated with impairments in executive neuropsychological functioning, specifically cognitive impulsivity. Further, it remains unclear how such impairments may relate of the nature, level and extent of opioid exposure, the presence and severity of opioid dependence, and hazardous behaviours such as injecting.

Method.

Participants with histories of illicit heroin use (n = 24), former heroin users stabilized on prescribed methadone (methadone maintenance treatment; MMT) (n = 29), licit opioid prescriptions for chronic pain without history of abuse or dependence (n = 28) and healthy controls (n = 28) were recruited and tested on a task battery that included measures of cognitive impulsivity (Cambridge Gambling Task, CGT), motor impulsivity (Affective Go/NoGo, AGN) and non-planning impulsivity (Stockings of Cambridge, SOC).

Results.

Illicit heroin users showed increased motor impulsivity and impaired strategic planning. Additionally, they placed higher bets earlier and risked more on the CGT. Stable MMT participants deliberated longer and placed higher bets earlier on the CGT, but did not risk more. Chronic opioid exposed pain participants did not differ from healthy controls on any measures on any tasks. The identified impairments did not appear to be associated specifically with histories of intravenous drug use, nor with estimates of total opioid exposure.

Conclusion.

These data support the hypothesis that different aspects of neuropsychological measures of impulsivity appear to be associated with exposure to different opioids. This could reflect either a neurobehavioural consequence of opioid exposure, or may represent an underlying trait vulnerability to opioid dependence.

Keywords

Cognitionimpulsivityneuropsychological assessmentopioid abuse
Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 6 , April 2015 , pp. 1167 - 1179
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

APA (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. American Psychiatric Association: Washington, DC.Google Scholar
Audrain-McGovern, J, Rodriguez, D, Epstein, LH, Cuevas, J, Rodgers, K, Wyleyto, EP (2009). Does delay discounting play an etiological role in smoking or is it a consequence of smoking? Drug and Alcohol Dependence 103, 99–106.Google Scholar
Baker, F, Johnson, MW, Bickel, WK (2003). Delay discounting in current and never-before cigarette smokers: similarities and differences across commodity, sign, and magnitude. Journal of Abnormal Psychology 11, 382–392.Google Scholar
Baldacchino, A (2001). Procedure for tolerance testing. NHS Fife, Fife (http://www.fifeadtc.scot.nhs.uk). Accessed 14 December 2013.Google Scholar
Baldacchino, A, Balfour, DJK, Passetti, F, Humphris, G, Matthews, K (2012). Neuropsychological consequences of chronic opioid use: a quantitative review and meta-analysis. Neuroscience and Biobehavioral Review 36, 2056–2068.Google Scholar
Barratt, ES (1985). Impulsiveness subtraits: arousal and information processing. In Motivation, Emotion and Personality (ed. Spence, J. T. and Izard, C. E.), pp. 137–146. Elsevier: North Holland.Google Scholar
Best, D, Manning, V, Strang, J (2007). Retrospective recall of heroin initiation and the impact on peer networks. Addiction Research Theory 15, 397–410.Google Scholar
Brand, M, Greco, R, Schuster, A, Kalbe, E, Fujiwara, E, Markowitsch, HJ, Kessler, J (2002). The game of dice -a new test for the assessment of risk taking behavior. Neurorehabilitation and Neural Repair 16, 142–143.Google Scholar
Bretteville-Jensen, AL (1999). Addiction and discounting. Journal of Health Economics 18, 393–407.CrossRefGoogle ScholarPubMed
Chamberlain, SR, Odlaug, BL, Schreiber, LR, Grant, JE (2012). Association between tobacco smoking and cognitive functioning in young adults. American Journal of Addiction 21, S14–S19.Google Scholar
Clark, L, Robbins, TW, Ersche, KD, Sahakian, BJ (2006). Reflection impulsivity in chronic and former substance users. Biological Psychiatry 60, 512–522.Google Scholar
Cole, C, Jones, L, McVeigh, J, Kicman, A, Syed, A, Bellis, M (2010). Adulterants in illicit drugs: a review of empirical evidence. Drug Testing and Analysis 3, 89–96.Google Scholar
Davis, AM, Inturrisi, CE (1999). d-Methadone blocks morphine tolerance and N-methyl-D-aspartate-induced hyperalgesia. Journal of Pharmacology and Experimental Therapeutics 289, 1048–1053.Google Scholar
Davis, PE, Liddiard, H, McMillan, TM (2002). Neuropsychological impairments and opiate abuse. Drug and Alcohol Dependence 67, 105–108.Google Scholar
Dawe, S, Loxton, NJ (2004). The role of impulsivity in the development of substance use and eating disorders. Neuroscience and Biobehavioral Review 28, 343–351.Google Scholar
Deakin, JB, Aitken, MRF, Robbins, TW, Sahakian, BJ (2004). Risk taking during decision-making in normal volunteers changes with age. Journal of the International Neuroscience Society 10, 590–598.Google Scholar
Deeb, TZ, Sharp, D, Hales, TG (2009). Direct subunit-dependent multimodal 5-hydroxytryptamine receptor antagonism by methadone. Molecular Pharmacology 75, 908–917.Google Scholar
Dougherty, DM, Mathias, CW, Marsh-Richard, DM, Furr, RM, Nouvion, SO, Dawes, MA (2009). Distinctions in behavioral impulsivity: implications for substance abuse research. Addiction Disorders and their Treatment 8, 61–73.Google Scholar
Drake, S, McDonald, S, Kaye, S, Torok, M (2012). Comparative patterns of cognitive performance amongst opioid maintenance patients, abstinent opioid users and non-opioid users. Drug and Alcohol Dependence 126, 309–315.Google Scholar
Ersche, K, Roiser, JP, Clark, L, London, M, Robbins, TW, Sahakian, BJ (2005). Punishment induces risky decision making in methadone maintained opiate users but not in heroin users or healthy volunteers. Neuropsychopharmacology 30, 2115–2124.CrossRefGoogle ScholarPubMed
Ersche, KD, Clark, L, London, M, Robbins, TW, Sahakian, BJ (2006). Profile of executive and memory function associated with amphetamine and opiate dependence. Neuropsychopharmacology 31, 1036–1047.Google Scholar
Ersche, KD, Sahakian, BJ (2007). The neuropsychology of amphetamine and opiate dependence: implications for treatment. Neuropsychology Review 17, 317–336.Google Scholar
Ersche, KD, Turton, AJ, Pradhan, S, Bullmore, ET, Robbins, TW (2010). Drug addiction endophenotypes: impulsive versus sensation-seeking personality traits. Biological Psychiatry 68, 770–773.Google Scholar
Fagerstrom, KO, Schneider, NG (1989). Measuring nicotine dependence: a review of the Fagerstrom Tolerance Questionnaire. Journal of Behavioral Medicine 12, 159–182.Google Scholar
Field, A (2009). Discovering Statistics Using SPSS, 3rd edn. SAGE Publications: London.Google Scholar
Fishbein, DH, Krupitsky, E, Flannery, BA, Langevin, DJ, Bobashev, J, Verbitskaya, E, Augustine, CB, Bolla, KI, Zvartau, E, Schech, B, Egorova, V, Bushara, N, Tsoy, M (2007). Neurocognitive characterizations of Russian heroin addicts without a significant history of other drug use. Drug and Alcohol Dependence 90, 25–38.Google Scholar
Flory, JD, Manuck, SB (2009). Impulsiveness and cigarette smoking. Psychosomatic Medicine 71, 431–437.Google Scholar
Grant, JE, Chamberlain, SR, Schreiber, L, Odlaug, BL (2012). Neuropsychological deficits associated with cannabis use in young adults. Drug and Alcohol Dependence 121, 159–162.Google Scholar
Gruber, SA, Silveri, MM, Yurgelun-Todd, DA (2007). Neuropsychological consequences of opiate use. Neuropsychological Review 17, 299–315.Google Scholar
Hodgson, J, McDonald, S, Tate, R, Gertler, P (2005). A randomised controlled trial of a cognitive-behavioural therapy program for managing social anxiety after acquired brain injury. Brain Impairment 6, 169–180.Google Scholar
Jollant, F, Guillaume, S, Jaussent, I, Castelnau, D, Malafosse, A, Courtet, P (2007). Impaired decision-making in suicide attempters may increase the risk of problems in affective relationships. Journal of Affective Disorder 99, 59–62.Google Scholar
Kirisci, L, Tarter, RE, Reynolds, M, Vanyukov, M (2006). Individual differences in childhood neurobehavior disinhibition predict decision to desist substance use during adolescence and substance use disorder in young adulthood: a prospective study. Addictive Behavior 31, 686–696.Google Scholar
Kollins, SH (2003). Delay discounting is associated with substance use in college students. Addictive Behavior 28, 1167–1173.CrossRefGoogle ScholarPubMed
Koob, GF, Volkow, ND (2010). Neurocircuitry of addiction. Neuropsychopharmacology 35, 217–238.Google Scholar
Leland, DS, Paulus, MP (2005). Increased risk-taking decision making but not altered response to punishment in stimulant-using young adults. Drug and Alcohol Dependence 78, 83–90.Google Scholar
Loeber, S, Kniest, A, Diehl, A, Mann, K, Croissant, B (2008). Neuropsychological functioning of opiate-dependent patients, a nonrandomized comparison of patients preferring either buprenorphine or methadone maintenance treatment. American Journal of Drug and Alcohol Abuse 34, 584–593.Google Scholar
Marsden, J, Gossop, G, Stewart, D, Best, D, Farrell, M, Lehmann, P, Edwards, C, Strang, J (1998). The Maudsley Addiction Profile (MAP): a brief instrument for assessing treatment outcome. Addiction 93, 1857–1867.CrossRefGoogle ScholarPubMed
McMorn, S, Schoedel, KA, Sellers, EM (2011). Effects of low-dose opioids on cognitive dysfunction. Journal of Clinical Oncology 29, 4342–4343.Google Scholar
Mintzer, MZ, Copersino, ML, Stitzer, ML (2005). Opioid abuse and cognitive performance. Drug and Alcohol Dependence 78, 225–230.Google Scholar
Nelson, HE (1982). National Adult Reading Test (NART): Test Manual. Nelson: Windsor.Google Scholar
Odum, AL, Bauman, AAL (2010). Delay discounting: state and trait variable. In Impulsivity: the Behavioral and Neurological Science of Discounting (ed. Madden, G. J. and Bickel, W. K.), pp. 39–65. American Psychological Association: Washington, DC.Google Scholar
Ornstein, TJ, Iddon, JL, Baldacchino, AM, Sahakian, BJ, London, M, Everitt, BJ, Robbins, TW (2000). Profiles of cognitive dysfunction in chronic amphetamine and heroin abusers. Neuropsychopharmacology 23, 113–126.Google Scholar
Owen, AM, Sahakian, BJ, Semple, J, Polkey, CE, Robbins, TW (1995). Visuo-spatial short-term recognition memory and learning after temporal lobe excisions, frontal lobe excisions or amygdalo-hippocampectomy in man. Neuropsychologia 33, 1–24.Google Scholar
Passetti, F, Clark, L, Mehta, MA, Joyce, E, King, M (2008). Neuropsychological predictors of clinical outcome in opiate addiction. Drug and Alcohol Dependence 94, 82–91.Google Scholar
Pasternak, GW (2012). Preclinical pharmacology and opioid combinations. Pain Medicine 13, S4–S11.Google Scholar
Pathan, H, Williams, J (2012). Basic opioid pharmacology: an update. British Journal of Pain 6, 11–16.Google Scholar
Patton, JH, Stanford, MS, Barratt, ES (1995). Factor structure of the Barratt Impulsiveness Scale. Journal of Clinical Psychology 51, 768–774.Google Scholar
Petry, NM (2002). Discounting of delayed rewards in substance abusers: relationship to antisocial personality disorder. Psychopharmacology 162, 425–432.Google Scholar
Potvin, S, Briand, C, Prouteau, A, Bouchard, RH, Lipp, O, Lalonde, P, Nicole, L, Lesage, A, Stip, E (2005). CANTAB explicit memory is less impaired in addicted schizophrenia patients. Brain Cognition 59, 38–42.Google Scholar
Reynolds, B, Ortengren, A, Richards, JB, de Wit, H (2006). Dimensions of impulsive behavior: personality and behavioral measures. Personality and Individual Differences 40, 305–315.Google Scholar
Robbins, TW, James, M, Owen, AM, Sahakian, BJ, McInnes, L, Rabbitt, P (1994). Cambridge Neuropsychological Test Automated Battery (CANTAB): a factor analytic study of a large sample of normal elderly volunteers. Dementia 5, 266–281.Google Scholar
Rotherham-Fuller, E, Shoptaw, S, Berman, SM, London, ED (2004). Impaired performance in a test of decision-making by opiate-dependent tobacco smokers. Drug and Alcohol Dependence 73, 79–86.Google Scholar
Sackett, DL (1979). Bias in analytic research. Journal of Chronic Diseases 32, 51–63.Google Scholar
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, GC (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59, 22–33.Google Scholar
Stanford, MS, Mathias, CW, Dougherty, DM, Lake, SL, Anderson, NE, Patton, JH (2009). Fifty years of the Barratt Impulsiveness Scale: an update and review. Personality and Individual Differences 47, 385–395.Google Scholar
Vassileva, J, Petkova, P, Georgiev, S, Martin, EM, Tersiyski, R, Raycheva, M, Velinov, V, Marinov, P (2007). Impaired decision-making in psychopathic heroin addicts. Drug and Alcohol Dependence 86, 287–289.Google Scholar
Verdejo-Garcia, A, Lawrence, AJ, Clark, L (2008). Impulsivity as a vulnerability marker for substance-use disorders: review of findings from high-risk research, problem gamblers and genetic association studies. Neuroscience and Biobehavioral Review 32, 777–810.Google Scholar
Verdejo-Garcıa, A, López-Torrecillas, F, Gimenez, CO, Pérez-García, M (2004). Clinical implications and methodological challenges in the study of the neuropsychological correlates of cannabis, stimulant, and opioid abuse. Neuropsychological Review 14, 1–41.Google Scholar
Verdejo-García, AJ, Pérez-García, M (2007). Profile of executive impairments in cocaine and heroin polysubstance users: common and differential effects on separate executive components. Psychopharmacology (Berl) 190, 517–530.Google Scholar
Vieweg, WVR, Lipps, WFC, Fernandez, A (2005). Opioids and methadone equivalents for clinicians. Primary care companion. Journal of Clinical Psychiatry 7, 86–88.Google Scholar
Wesson, DR, Ling, W (2003). The Clinical Opiate Withdrawal Scale (COWS). Journal of Psychoactive Drugs 35, 253–259.CrossRefGoogle ScholarPubMed
Winer, BJ, Brown, DR, Michels, KM (1991). Statistical Principles in Experimental Design, 3rd edn. McGraw Hill: New York.Google Scholar
Supplementary material: File

Baldacchino Supplementary Material

Supplementary Tables

Download Baldacchino Supplementary Material(File)
File 19.3 KB