Stress and opioid use disorder: A systematic review

Area of Science:

• Addiction Medicine
• Psychology
• Clinical Research

Background:

• Medication assisted treatment (MAT) is effective for opioid use disorder (OUD), but treatment retention remains a challenge.
• Stress perception may influence patient decisions to discontinue OUD treatment.
• Understanding the relationship between stress and OUD treatment outcomes is crucial for improving patient care.

Purpose of the Study:

• To systematically review empirical studies on the primary appraisal of stress and its association with opioid craving, opioid use, and OUD treatment outcomes.
• To identify potential interventions for managing stress within OUD treatment settings.
• To inform future research directions for addressing stress in OUD.

Main Methods:

• Systematic review of multiple databases for empirical studies.
• Inclusion of studies measuring primary appraisal of stress (self-reported perception of stress).
• Categorization of studies into observed stress, experimentally-induced stress, and stress-focused interventions.

Main Results:

• Appraised stress generally correlated with increased opioid craving.
• Associations between appraised stress and opioid use or treatment retention were inconsistent.
• Most studies included patients in MAT and receiving drug counseling, indicating stress persists despite standard care.
• Psychopharmacological interventions targeting stress showed promise, but behavioral stress management interventions were lacking.

Conclusions:

• Individuals with OUD experience significant stress even within standard treatment protocols.
• Targeting stress, particularly through psychopharmacological agents like clonidine and lofexidine, warrants further investigation.
• Future research should incorporate daily life stress assessments and explore behavioral stress management techniques to enhance OUD treatment outcomes.