Attentional bias for prescription opioid cues among opioid dependent chronic pain patients

Recurrent use of prescription opioid analgesics by chronic pain patients may result in opioid dependence, which involves implicit
neurocognitive operations that organize and impel craving states and compulsive drug taking behavior. Prior studies have identified
an attentional bias (AB) towards heroin among heroin dependent individuals. The aim of this study was to determine whether
opioid-dependent chronic pain patients exhibit an AB towards prescription opioid-related cues. Opioid-dependent chronic pain
patients (n = 32) and a comparison group of non-dependent opioid users with chronic pain (n = 33) completed a dot probe task
designed to measure opioid AB. Participants also rated their opioid craving and self-reported arousal associated with opioid-related
and neutral images, pain severity, and relief from pain treatments. Repeated-measures ANOVA revealed a significant group (opioid-dependent
vs. non-dependent opioid user) × presentation duration (200. vs. 2,000 ms.) interaction, such that opioid-dependent individuals
evidenced a significant AB towards opioid cues presented for 200 ms but not for cues presented for 2,000 ms, whereas non-dependent
opioid users did not exhibit a significant mean AB at either stimulus duration. Among opioid-dependent individuals, 200 ms
opioid AB was significantly associated with opioid craving, while among non-dependent opioid users, 200 ms opioid AB was significantly
associated with relief from pain treatments. Furthermore, dependent and non-dependent opioid users experienced opioid cues
as significantly more arousing than neutral cues. Opioid dependence among chronic pain patients appears to involve an automatic
AB towards opioid-related cues. When coupled with chronic pain, attentional fixation on opioid cues may promote compulsive
drug use and addictive behavior.