tDCS to Decrease Opioid Relapse

丁丙诺啡已成为治疗阿片使用障碍(OUD)的主要药物，但接受者的 早期复发率可能是由于渴望和认知控制神经元内不同程度的功能障碍所致 网络。经颅直流电刺激(Tdcs)作为辅助治疗可能有希望。 丁丙诺啡引发剂，因为大量关于成瘾物质的研究表明，治疗的目标是 背外侧前额叶皮质(DLPFC；参与自我调节的区域)可能会减少渴望和药物 消费。我们将测量刺激TDC后对DLPFC的行为和大脑反应 在认知控制网络(CCN)启动期间提供。参与者在他们规定的第一个星期 丁丙诺啡将使用功能磁共振成像进行两次评估，一次在tdcs+CCN预注之前，另一次在tdcs+ccn预注之前。 完成5次tdcs+ccn预充(一周后)。基于任务和休息状态的功能 连接性将被用来研究与渴望(CR)和认知控制相关的网络。在UG3中 阶段(n=60)，功能磁共振成像将验证这些网络在tdcs刺激后的预期变化。 UH3阶段的GO/NO GO标准将显示CR或 CCN网络和主观渴求的更大变化在测量之前(在fMRI扫描之外)或在 TDCs+CCN预激干预后的fMRI提示反应任务与假TDCs+CCN的比较 引爆。在UH3阶段(n=100)，我们将执行更大的RCT(与Sham对照)以解决长期问题 神经行为结果，包括阿片类药物复发、渴求和持续的fMRI变化。因为tdcs是 安全、廉价和便携，如果这种干预提供了靶向大脑效应的fMRI验证和 产生临床反应，这可能会对加强丁丙诺啡患者的护理产生重大影响 治疗，一个治疗失败的高风险人群。

Buprenorphine has emerged as a leading treatment for opioid use disorder (OUD), but recipients have high early relapse rates likely due to varying degrees of dysfunction within craving and cognitive control neuronal networks. Transcranial direct current stimulation (tDCS) may have promise as adjuvant treatment for buprenorphine initiators because considerable work on addictive substances suggests treatment targeted at the dorsolateral prefrontal cortex (DLPFC; region involved in self-regulation) may reduce craving and drug consumption. We will measure behavioral and brain responses following tDCS stimulation to the DLPFC delivered during cognitive control network (CCN) priming. Participants in their first week of prescribed buprenorphine will be assessed twice using FMRI, once prior to tDCS+CCN priming and again at the completion of 5 sessions of tDCS+CCN priming (one week later). Task-based and resting state functional connectivity will be used to examine networks associated with craving (CR) and cognitive control. In the UG3 phase (n=60), FMRI will provide validation of expected changes in these networks following tDCS stimulation. Go/no go criteria for the UH3 phase will be demonstration of greater FMRI change in any node of the CR or CCN networks AND greater change in subjective craving measured prior to (outside FMRI scan) or during an FMRI cue reactivity task following the tDCS+CCN priming intervention compared to sham tDCS+CCN priming. In the UH3 phase (n=100), we will perform a larger RCT (vs. sham control) to address long-term neurobehavioral outcomes, including opioid relapse, craving, and sustained fMRI changes. Because tDCS is safe, inexpensive and portable, if this intervention provides FMRI validation of targeted brain effects and produces clinical response, it could have great impact augmenting the care of persons entering buprenorphine treatment, a population at high risk for treatment failure.