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Episode 40 | The Effect of Opioid Use and Treatment on Cognition With Dr. Monica Rivera Mindt


Overview

We brought Monica Rivera Mindt, Ph.D., ABPP-CN, back on the podcast to discuss the cognitive effects of opioid use (both licit and illicit). We discuss the history of the opioid epidemic in the U.S., the neurobiology of opioids, and common treatments for opioid use disorder.



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Monica Rivera Mindt
Instructor Credentials

Monica Rivera Mindt, Ph.D., ABPP-CN, is a Professor of Psychology and Director of the Clinical Psychology Doctoral Program at Fordham University. She has a joint appointment in Neurology at Icahn School of Medicine at Mount Sinai in New York City. Dr. Rivera Mindt’s mission is to advance equity in brain health. She is focused on developing culturally tailored interventions to improve health outcomes among disenfranchised populations. Specifically, she is interested in the underlying mechanisms driving the effects of sociocultural, behavioral, medical, and genetic factors on neurocognitive function and decline in persons of culturally/linguistically diverse backgrounds. In addition to serving as the President of the Hispanic Neuropsychological Society (HNS), she is the inaugural Editor for the Culture & Gender in Neuropsychology Department of The Clinical Neuropsychologist journal. She is a Fellow of the American Psychological Association and the National Academy of Neuropsychology.


Topics Covered

Introduction

  • We discuss two upcoming projects, Neuropsych Bites and our book, Becoming a Neuropsychologist (00:36)
  • We define terminology (2:49)
  • Risk of opioid use disorder for treatment of chronic pain (3:03)
  • Incidence of opioid use disorder in the U.S. (3:27)
  • Opioid mortality rates (4:37)
  • Center for Disease Control and Prevention (CDC) guidelines for prescribing opioids for chronic pain (5:59)
  • DSM-V criteria for opioid use disorder (7:29)

Interview with Dr. Monica Rivera Mindt

  • Historical context of the opioid epidemic (10:52)
  • Fentanyl use (14:17)
  • At-risk populations for opioid use (15:22)
  • Highest overdose rates in the U.S. are in the Appalachia mountain range (15:58)
  • Mesolimbic reward pathway (16:28)
  • Other neuroanatomical structures implicated in opioid use (18:41 and 37:50)
  • The reason opioids are more addictive than stimulants, despite both drugs being involved in the same reward system (19:29)
  • Common pathways to addiction and opioid use disorder (20:46)
  • Harm reduction interventions for opioid use (25:02)
  • Mechanisms for three types of pharmacological treatments for opioid use – opioid agonist, opioid partial agonist, and opioid antagonist (27:12)
  • Duration of maintenance therapies (30:10)
  • The effects of maintenance therapies on cognition (33:03)
  • Whether drug use causes cognitive deficits or whether individuals with cognitive deficits have a higher risk of using drugs (37:02)
  • Dose-dependent relationship of opioid use and cognitive deficits (39:22)
  • Whether illicit or licit drugs have different effects on cognition (52:41)
  • Opioid use and risk for polysubstance use (40:36)
  • Role of a clinical neuropsychologist in the opioid epidemic (43:22 and 48:41)
  • The appropriate time to test individuals who are currently using opioids (47:10)
  • The significance of clinical neuropsychologists collaborating with other healthcare professionals (48:01)
  • Cognitive interventions for individuals who are using opioids (53:22)
  • Monica recommends the harm reduction approach to treating opioid use disorder (55:46)
Educational Objectives
  • Describe the sociohistorical underpinnings of the opioid crisis
  • List neurobiological structures and networks impacted by opioids
  • Discuss the cognitive effects of opioid agonist treatments (OATs)
Target Audience
  • Introductory
Availability
  • Date Available: 2019-06-01
  • You may obtain CE for this podcast at any time.
Offered for CE
  • Yes
Cost
  • Members $20
  • Non-Members $25
Refund Policy
  • This podcast is not eligible for refunds
CE Credits
  • 1.0 Credit(s)
Disclosures
  • N/A
Resources
  • N/A
Bibliography
  • Arias, F., Arnsten, J. H., Cunningham, C. O., Coulehan, K., Batchelder, A., Brisbane, M., et al. (2016). Neurocognitive, psychiatric, and substance use characteristics in opioid dependent adults. Addict Behav, 60, 137-143.
  • Baldacchino, A., Balfour, D. J., Passetti, F., Humphris, G., & Matthews, K. (2012). Neuropsychological consequences of chronic opioid use: a quantitative review and meta-analysis. Neurosci Biobehav Rev, 36(9), 2056-2068.
  • Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC Guideline for Prescribing Opioids for Chronic Pain–United States, 2016. JAMA, 315(15), 1624-1645.
  • Kiang, M. V., Basu, S., Chen, J., & Alexander, M. J. (2019). Assessment of Changes in the Geographical Distribution of Opioid-Related Mortality Across the United States by Opioid Type, 1999-2016. JAMA Netw Open, 2(2), e190040.
  • NIDA. (2020). Opioid Overdose Crisis. Retrieved March 15, 2020, from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis
  • Scott, T. M., Rivera Mindt, M., Cunningham, C. O., Arias, F., Coulehan, K., Mangalonzo, A., et al. (2017). Neuropsychological function is improved among opioid dependent adults who adhere to opiate agonist treatment with buprenorphine-naloxone: a preliminary study. Subst Abuse Treat Prev Policy, 12(1), 48.
  • Stone, K., & Shirley-Beavan, S. Global state of harm reduction 2018. Londol: Harm Reduction International; 2018.
  • Tinker, B. (2019). These States Have Been Hit the Hardest by America’s Opioid Epidemic. Retrieved March 15, 2020, from https://www.cnn.com/2019/02/22/health/opioid-deaths-states-study/index.html
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