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Front. Psychiatry | doi: 10.3389/fpsyt.2019.00592

Craving in Opioid Use Disorder: From Neurobiology to Clinical Practice

  • 1Department of Clinical Sciences, Umeå University, Sweden
  • 2Department of Public Health Solutions, National Institute for Health and Welfare, Finland
  • 3Division of Population and Behavioural Science, School of Medicine, University of St Andrews, United Kingdom
  • 4Center of Attention to the Addictions, Madrid Health Service, Spain
  • 5University of Padova, Italy
  • 6Indivior UK Limited, United Kingdom

Opioid use disorder (OUD) is a major public health issue that has reached epidemic levels in some parts of the world. It is a chronic and complex neurobiological disease associated with frequent relapse to drug taking. Craving, defined as an overwhelmingly strong desire or need to use a drug, is a central component of OUD and other substance-use disorders. In this review, we describe the neurobiological and neuroendocrine pathways which underpin craving in OUD and also focus on the importance of assessing and treating craving in clinical practice. Craving is strongly associated with patients returning to opioid misuse, and is therefore an important treatment target in order to reduce the risk of relapse and improve patients’ quality of life. Opioid agonist therapies such as buprenorphine and methadone can significantly reduce craving and relapse risk and it is essential that patients are treated optimally with these therapies. There is also evidence to support the benefits of non-pharmacological approaches such as cognitive behavioral therapy and mindfulness-based interventions as a supplementary treatment to opioid agonist therapies. However, despite the positive impact of these treatments on craving, many OUD patients continue to suffer with negative affect and dysphoria. There is a clear need for further studies to progress our understanding of the neurobiological basis of craving and addiction and to identify novel therapeutic strategies as well as to optimize the use of existing treatments in order to improve outcomes for the growing numbers of patients affected by OUD.

Keywords: opioid, craving, Addiction, negative affect, Methadone, Buprenorphine

Received: 17 Apr 2019; Accepted: 26 Jul 2019.

Edited by:

LUIGI JANIRI, Catholic University of the Sacred Heart, Italy

Reviewed by:

Oussama KEBIR, Institut National de la Santé et de la Recherche Médicale (INSERM), France
Chiara Montemitro, Department of Neuroscience, Imaging and Clinical Sciences, G. d'Annunzio University of Chieti and Pescara, Italy  

Copyright: © 2019 Kakko, Alho, Baldacchino, Molina, Nava and Shaya. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Johan Kakko, Department of Clinical Sciences, Umeå University, Umeå, 901 87, Västerbotten, Sweden, kakko.johan@gmail.com