The demand for opioid medication to effectively treat pain has contributed to the surging opioid crisis, which is a major source of morbidity and mortality in the U.S. More than 100,000 people begin opioid maintenance treatment (OMT) annually, the standard pharmacotherapy for opioid use disorder (OUD). Although OMT is the standard care for OUD, patients often experience or develop a heightened sensitivity to pain (hyperalgesia) as a result of the opioid medication, and also have high rates of stress, affective, and anxiety-related conditions. These conditions are interactive with other behavioral and environmental correlates of opioid and other substance use disorders including impulsive decision-making (e.g., harmful opioid use associated with increased delay discounting), and a lack of alternative (i.e., substance-free) and social reinforcement. Collectively these complex and multifaceted factors constitute significant predictors of lack of adherence to OMT (and other pharmacotherapies) and relapse. There is an urgent need, therefore, to develop novel adjunctive treatments that preserve the benefits of OMT and various pharmacotherapies, and simultaneously diminish continued pain and hyperalgesia, reduce stress and anxiety-related conditions, target relevant behavioral mechanism such as impulsive choice, and also serve to enhance the value of alternative and substance free activities. Here, we discuss evidence that an environmental manipulation – access to greenspace and nature – could serve as a potential adjunctive treatment to standard pharmacotherapies by targeting multiple biological and behavioral mechanisms that standard pharmacotherapies do not address.

对有效治疗疼痛的阿片类药物的需求导致了阿片类药物危机的激增，这是美国发病率和死亡率的一个主要原因。每年有超过 100,000 人开始阿片类药物维持治疗 (OMT)，这是阿片类药物使用障碍的标准药物治疗。沉香木）。尽管 OMT 是 OUD 的标准护理，但患者经常因阿片类药物而经历或出现对疼痛高度敏感（痛觉过敏），并且出现压力、情感和焦虑相关病症的比例也很高。这些状况与阿片类药物和其他物质使用障碍的其他行为和环境相关因素相互作用，包括冲动决策（例如，与增加延迟折扣相关的有害阿片类药物使用）以及缺乏替代方案（即无物质）和社会强化。总的来说，这些复杂且多方面的因素构成了缺乏 OMT（和其他药物疗法）依从性和复发的重要预测因素。因此，迫切需要开发新的辅助治疗，以保留 OMT 和各种药物疗法的益处，同时减少持续的疼痛和痛觉过敏，减轻压力和焦虑相关状况，针对相关的行为机制（例如冲动选择），以及旨在提高替代性和无物质活动的价值。在这里，我们讨论的证据表明，环境操纵——进入绿色空间和自然——可以通过针对标准药物疗法无法解决的多种生物和行为机制，作为标准药物疗法的潜在辅助治疗。