The current opioid epidemic is an urgent public health problem, with enormous individual, societal, and healthcare costs. Despite effective, evidence-based treatments, there is significant individual variability in treatment responses and relapse rates are high. In addition, the neurobiology of opioid-use disorder (OUD) and its treatment is not well understood. This review synthesizes published fMRI literature relevant to OUD, with an emphasis on findings related to opioid medications and treatment, and proposes areas for further research. We conducted a systematic literature review of Medline and Psychinfo to identify (i) fMRI studies comparing OUD and control participants; (ii) studies related to medication, treatment, abstinence or withdrawal effects in OUD; and (iii) studies involving manipulation of the opioid system in healthy individuals. Following application of exclusionary criteria (e.g., insufficient sample size), 45 studies were retained comprising data from ~1400 individuals. We found convergent evidence that individuals with OUD display widespread heightened neural activation to heroin cues. This pattern is potentiated by heroin, attenuated by medication-assisted treatments for opioids, predicts treatment response, and is reduced following extended abstinence. Nonetheless, there is a paucity of literature examining neural characteristics of OUD and its treatment. We discuss limitations of extant research and identify critical areas for future neuroimaging studies, including the urgent need for studies examining prescription opioid users, assessing sex differences and utilizing a wider range of clinically relevant task-based fMRI paradigms across different stages of addiction.

中文翻译：

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神经影像学可以帮助对抗阿片类药物的流行吗？对临床和药理学挑战功能磁共振成像研究的系统回顾以及对未来研究的建议。

当前的阿片类药物流行是一个紧迫的公共卫生问题，造成巨大的个人、社会和医疗保健成本。尽管有有效的、基于证据的治疗，但治疗反应存在显着的个体差异，并且复发率很高。此外，阿片类药物使用障碍（OUD）的神经生物学及其治疗尚不清楚。本综述综合了已发表的与 OUD 相关的功能磁共振成像文献，重点关注与阿片类药物和治疗相关的研究结果，并提出了进一步研究的领域。我们对 Medline 和 Psychinfo 进行了系统的文献综述，以确定 (i) 比较 OUD 和对照参与者的 fMRI 研究；(ii) 与 OUD 的药物、治疗、戒断或戒断效应相关的研究；(iii) 涉及在健康个体中操纵阿片类药物系统的研究。应用排除标准（例如样本量不足）后，保留了 45 项研究，其中包含来自约 1400 名个体的数据。我们发现一致的证据表明，患有 OUD 的个体对海洛因线索表现出广泛的神经激活。这种模式因海洛因而增强，因阿片类药物的药物辅助治疗而减弱，可预测治疗反应，并在长期戒酒后减弱。尽管如此，研究 OUD 神经特征及其治疗的文献却很少。我们讨论了现有研究的局限性，并确定了未来神经影像学研究的关键领域，包括迫切需要研究检查处方阿片类药物使用者、评估性别差异以及在成瘾的不同阶段利用更广泛的临床相关的基于任务的功能磁共振成像范式。