Am J Psychiatry 2008; 165:390-394
(published online December 3, 2007; doi: 10.1176/appi.ajp.2007.07010070)
© 2008 American Psychiatric Association
Acute Effect of Methadone Maintenance Dose on Brain fMRI Response to Heroin-Related Cues
Daniel D. Langleben, M.D.,
Kosha Ruparel, M.S.E.,
Igor Elman, M.D.,
Samantha Busch-Winokur, B.A.,
Ramapriyan Pratiwadi, B.S.E.,
James Loughead, Ph.D.,
Charles P. O’Brien, M.D., Ph.D., and
Anna R. Childress, Ph.D.
OBJECTIVE: Environmental drug-related cues have been implicated as a cause of illicit heroin use during methadone maintenance treatment of heroin dependence. The authors sought to identify the functional neuroanatomy of the brain response to visual heroin-related stimuli in methadone maintenance patients. METHOD: Event-related functional magnetic resonance imaging was used to compare brain responses to heroin-related stimuli and matched neutral stimuli in 25 patients in methadone maintenance treatment. Patients were studied before and after administration of their regular daily methadone dose. RESULTS: The heightened responses to heroin-related stimuli in the insula, amygdala, and hippocampal complex, but not the orbitofrontal and ventral anterior cingulate cortices, were acutely reduced after administration of the daily methadone dose. CONCLUSIONS: The medial prefrontal cortex and the extended limbic system in methadone maintenance patients with a history of heroin dependence remains responsive to salient drug cues, which suggests a continued vulnerability to relapse. Vulnerability may be highest at the end of the 24-hour interdose interval.
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