Persistent and Abusive Use of Opioids: Short- and Long-Term Effects on the Brain

Brain injury professionals affiliated with the Academy of Certified Brain Injury Specialists (ACBIS) have reported an unprecedented uptick in the number of people they serve who have suffered a brain injury due to substance abuse, in particular, opioid dependence. This dovetails with the significant increase in opioid-related morbidity and mortality rates reported across public health agencies. In recent years, there has been a great deal of attention placed on the opioid crisis with reports of overdoses and the mounting death toll, but there has been little attention focused on the brain injuries that result from persistent opioid use.

Pain relief and euphoria are achieved in opioid use when the drug crosses the blood-brain barrier to access the central nervous system (Schaefer, Tome & Davis, 2017). While the user feels a temporary sense of well-being, persistent use creates a dysregulation of dopamine transmission, and a co-occurring impairment in the frontal brain regions impacts cognition and function (Tolomeo, Gray, Matthews, Steel & Baldacchino, 2016). In addition to the cognitive and functional changes, imaging has documented volume loss in the brain associated with long-term use of opioids. Even several years into recovery, people who abused opioids continue to experience cognitive impairments, indicating the dysfunction is long-term and not due solely to the presence of the drug (Ersche, Clark, London, Robbins & Sahakian, 2006).

In some studies, measures of neurocognitive function have shown that people with opioid dependence demonstrate impairments in the areas of memory, attention, spatial planning, and executive functions. There is also evidence that information processing speed is negatively impacted by chronic opioid use, causing difficulty with adjusting to new situations or learning new information, skills that are essential in the recovery process (Darke, McDonald, Kaye & Torok, 2012). Additionally, people abusing opioids struggle with solving complex problems and spend less time gathering information and reflecting on a course of action, impacting decision making and reasoning (Tolomeo et al., 2016).

The impact of the brain injury and the related cognitive deficits due to opioid abuse is significant, as issues such as impaired problem-solving and impulse control may increase drug seeking and risk-taking behaviors, as well as limit full engagement and compliance in treatment and recovery programs. It is clear from imaging and neurocognitive testing that opioid abuse can result in a brain injury that may have long-lasting implications for sustainable recovery, community participation, and quality of life. As such, brain injury programs treating individuals with impairments resulting from opioid dependence must address factors that contribute to brain health and optimal cognitive functioning, including neuronutrition, stress management, and cognitive rehabilitation. Cognitive rehabilitation, focused on developing attention, memory and information processing skills, along with impulse control and executive functions, is essential in treating both the addiction and the brain injury.

References

Darke, S. McDonald, S., Kaye, S. & Torok, M. (2012). Comparative patterns of cognitive performance amongst opioid maintenance patients, abstinent opioid used and non-opioid users. Drug and Alcohol Dependence. 126, 309-315.

Ersche, K. D., Clark, L. London, M., Robbins, T. W. & Shahakian, B. J. (2006). Profile of executive and memory function associated with amphetamine and opiate dependence. Neuropsychopharmacology. 31(5), 1036-1047.

Schaeffer, C. P., Tome, M. E. & Davis, T. P. (2017). The opioid epidemic: A central role for the blood brain barrier in opioid analgesia and abuse. Fluids and Barriers of the CNS. 14(32). 1-11.

Tolomeo, S., Gray, K., Steele, J. D. & Baldacchino, A. (2016). Multifaceted impairments in impulsivity and brain structure abnormalities in opioid dependence and abstinence. Psychological Medicine. 46, 2841-2853.

This article was contributed by Rita Cola Carroll, Ph.D.