Acute effect of methadone maintenance dose on brain FMRI response to heroin-related cues.
OBJECTIVE
Environmental drug-related cues have been implicated as a cause of illicit heroin use during methadone maintenance treatment of heroin dependence. The authors sought to identify the functional neuroanatomy of the brain response to visual heroin-related stimuli in methadone maintenance patients.


METHODS
Event-related functional magnetic resonance imaging was used to compare brain responses to heroin-related stimuli and matched neutral stimuli in 25 patients in methadone maintenance treatment. Patients were studied before and after administration of their regular daily methadone dose.


RESULTS
The heightened responses to heroin-related stimuli in the insula, amygdala, and hippocampal complex, but not the orbitofrontal and ventral anterior cingulate cortices, were acutely reduced after administration of the daily methadone dose.


CONCLUSIONS
The medial prefrontal cortex and the extended limbic system in methadone maintenance patients with a history of heroin dependence remains responsive to salient drug cues, which suggests a continued vulnerability to relapse. Vulnerability may be highest at the end of the 24-hour interdose interval.
Langleben
Daniel D
DD
Department of Psychiatry, University of Pennsylvania, Treatment Research Center, Philadelphia, PA 19104, USA. langlebe@upenn.edu
Ruparel
Kosha
K
Elman
Igor
I
Busch-Winokur
Samantha
S
Pratiwadi
Ramapriyan
R
Loughead
James
J
O'Brien
Charles P
CP
Childress
Anna R
AR
D000208:Acute Disease; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D016739:Behavior, Addictive / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D001921:Brain / Q000187:drug effects / Q000503:physiopathology*; D003463:Cues; D004305:Dose-Response Relationship, Drug; D005260:Female; D005625:Frontal Lobe / Q000187:drug effects / Q000503:physiopathology; D007839:Functional Laterality / Q000502:physiology; D003932:Heroin; D006556:Heroin Dependence / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008691:Methadone / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D010100:Oxygen / Q000097:blood; D055502:Secondary Prevention; D014796:Visual Perception / Q000502:physiology
D000701:Analgesics, Opioid; D003932:Heroin; D010100:Oxygen; D008691:Methadone