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Focusing on craving can lead to new opioid use disorder treatments

Addiction experts recommend reconsidering craving and its role in the development of opioid use disorder treatments, in a viewpoint published in JAMA Psychiatry.

“Ideally, an intervention that reduces opioid craving would improve patient functioning by lessening this aversive and intrusive experience while helping to prevent relapse,” Eric C. Strain, MD, from the department of psychiatry and behavioral sciences, Johns Hopkins University School of Medicine, and colleagues wrote. “However, some have questioned the utility of craving as a treatment outcome, and there is a long history recognizing challenges in the phenomenological characterization of craving as evidenced by the lack of a psychometrically sound measure of opioid craving.”

To create novel treatments that address craving and help patients in the recovery process, Strain and colleagues recommended:

• developing a psychometrically validated measure of craving;
• addressing inconsistency in craving as a function of individual and contextual factors; and
• evaluating craving across the drug use and treatment trajectory.

In opioid use disorder-related research, few craving measures are evaluated for validity across diverse patient populations and many are limited to craving for heroin rather than opioids, according to Strain and colleagues. To develop a psychometrically validated opioid craving evaluation, they recommended collecting patient and clinician input about content and format, undergoing testing in heterogeneous populations and including different terms (like urge or desire) that may play a role in craving.

The researchers advise that research should focus on specific individual-level variables — like motivation to quit, impulsivity and comorbid psychiatric disorders — and external environmental variables — like exposure to stressful situation, opioid use-related drug cues and access to opioids.

A person’s treatment status can also impact craving, which may vary across time during different phases of active opioid use, withdrawal, early abstinence and longer-term abstinence; therefore, conceptual models and measures should incorporate these factors, according to Strain and colleagues. They also noted that craving and opioid use can exist independent from each other.

“Just as some people eat when they are not hungry, some individuals with substance use disorders use drugs without experiencing craving, but more out of habit,” they explained. “Conversely, some people in recovery from substance use disorders experience powerful cravings but successfully resist them.”

Strength of craving and resistance may impact the likelihood of drug use, highlighting the need for craving-focused treatment, the researchers wrote.

“A renewed focus on craving, including the affective, cognitive, and behavioral facets that are a part of it and that can influence it, has the potential to open up new avenues for understanding its biologic basis and developing novel treatments,” they wrote. “This, in turn, may help to address the devastating consequences experienced by patients who struggle with overcoming opioid misuse.” – by Savannah Demko

Disclosures: Please see the full study for all authors’ relevant disclosures.