Examining Highly Palatable Food Consumption upon Initiation of Methadone Maintenance Treatment

摘要 过去十年中阿片类药物使用障碍（OUD）的增加已经造成了公共卫生危机。美沙酮 维持治疗（MMT）是OUD最常见的治疗方法。虽然MMT有效地帮助 患者的生活质量得到改善，身体和精神健康共病很常见， 过早死亡虽然不健康的生活方式行为，如缺乏运动和吸烟， 虽然这一群体的营养摄入量一直是目标，但相对而言，这一群体的营养摄入量的作用尚未得到探讨。临床 一直观察到体重显著增加（至少10%），以及经常报告的渴望 对甜食的需求现有文献中缺少的是对为什么这一点的清晰理解。 这种现象的发生，限制了通过适当干预有效解决这一问题的能力。 对体重增加的解释包括增加食物摄入量以补偿 在活跃的非法阿片类药物使用期间的营养不良和美沙酮对 胰腺细胞功能障碍和甜味偏好。然而，这些可能性只能部分解释 体重增加，因为大多数开始治疗的患者已经超重或肥胖， 即使美沙酮剂量稳定，也会继续使用。我们提出了一个额外的假设： 开始MMT将消耗高度可口的食物（HPF;即，高脂肪、高糖或两者），以努力 管理在早期恢复期间常见的负面影响和阿片类药物的渴望。有传闻说 物质使用治疗的患者为这一假设提供了支持- HPF提供了情绪缓解， 减少对药物的渴望。新出现的基础科学文献表明， HPF和药物滥用的机制。与药物一样，HPF增强内源性阿片样物质， 多巴胺释放在脑桥核，这，通过反复过度消费，也可以导致 破坏奖励途径。事实上，在非物质使用人群中，HPF的过度消费可导致 心理功能较差，如抑郁和焦虑（已知OUD患者有复发风险）。 因此，虽然HPF可能对改善负面情绪和减少负面情绪有短期的有益作用， 在MMT患者中，阿片类药物的渴望，它也可能赋予该人群复发的长期风险。 了解负面影响，阿片类药物渴望和消费之间的内在联系 在日常水平和早期MMT启动过程中的HPF对于告知 在这一高危人群中采取以营养为重点的干预措施。我们建议进行为期26周的 前瞻性研究80例患者最近开始MMT利用生态瞬时评估（EMA; 21天的比赛）。在这样做的时候，我们可以回答这样一个问题： 早期MMT对恢复非法阿片类药物使用的风险有利或有害。有了这些信息，更多 可以制定有效的干预措施，以延长恢复期，减少吸毒过量对公共卫生的影响。

Abstract Increases in Opioid Use Disorder (OUD) in the last decade has created a public health crisis. Methadone maintenance treatment (MMT) is the most common treatment for OUD. While MMT is effective in helping patients improve their quality of life, physical and mental health comorbidities are common and increase risk for premature death. While unhealthy lifestyle behaviors such as physical inactivity and cigarette smoking have been targeted, the role of nutritional intake in this population has been relatively unexplored. Clinically significant increases in weight (at least 10%) have been consistently observed, as well as oft-reported cravings for sweet foods upon MMT initiation. Missing from the existing literature is a clear understanding of why this phenomenon occurs, limiting the ability to effectively target this problem with appropriate intervention. Purported explanations for weight gain have included increased food intake to compensate for undernourishment during the time of active illicit opioid use and the pharmacological effects of methadone on pancreatic cell dysfunction and sweet taste preference. However, these possibilities may only partially explain weight gain as most patients starting treatment are already overweight or obese and increases in weight continue even when methadone doses are stable. We are proposing an additional hypothesis: patients starting MMT will consume foods that are highly palatable (HPF; i.e., high in fat, sugar, or both) in an effort to manage negative affect and opioid cravings that are common during early recovery. Anecdotal reports of patients in substance use treatment provide support for this hypothesis – HPF provide emotional relief and decrease drug cravings. An emerging body of basic science literature demonstrates shared neural mechanisms of both HPF and drugs of abuse. As with drugs, HPF potentiates endogenous opioid and dopamine release in the nucleus accumbens, which, through repeated overconsumption, can also lead to disrupted reward pathways. Indeed, in non-substance using populations, overconsumption of HPF can lead to poorer psychological functioning such as depression and anxiety (known relapse risks in those with OUD). Therefore, while HPF may have a short-term beneficial effect on improving negative affect and decreasing opioid cravings among patients in MMT, it may also confer a longer-term risk for relapse in this population. Understanding the within-person associations between negative affect, opioid cravings, and consumption of HPF at the daily level and over the course of early MMT initiation is critical for informing the development of adjunctive, nutrition-focused interventions in this at-risk population. We propose to conduct a 26-week prospective study of 80 patients who recently initiated MMT utilizing ecological momentary assessment (EMA; through three, 21-day bouts). In doing so, we can answer the question of whether HPF consumption during early MMT is beneficial or detrimental to risk for returning to illicit opioid use. With this information, more effective interventions could be developed to extend recovery and decrease the public health impact of OUD.