Non‐medical prescription opioid use (NMPOU) is at the heart of the opioid epidemic in the United States. Although chronic opioid use is commonly accompanied by deficits in social functioning, little is known about the impact of chronic NMPOU on social cognitive functions. Social neuroscience models suggest that empathy activates similar or even equivalent neural structures as those underpinning the first‐hand experience in that emotional state (e.g., pain). Therefore, we measured subjective and psychophysiological responses during an empathy‐for‐pain task in 23 individuals with NMPOU, objectively confirmed by hair and urine testing, and compared them with 29 opioid‐naïve healthy controls. NMPOU individuals showed lower other‐related and self‐related unpleasantness ratings when seeing others in pain than controls. No differences between the control and NMPOU group were found in skin conductance responses and heart rate variability (HRV) assessed by root mean square of successive differences (RMSSD) in response to the task. However, RMSSD‐HRV was strongly negatively correlated with self‐related unpleasantness and craving in the NMPOU group. A subsequent mediation analysis showed a total effect of RMSSD‐HRV on self‐related unpleasantness with no mediation of craving. This indicates that stronger emotion regulation indexed by high RMSSD‐HRV might have downregulating effects on sharing others’ pain in NMPOU individuals but not in healthy controls, which was further accompanied by decreased ratings of personal distress and empathetic concern. These results contribute to a better understanding of social functioning in chronic opioid users, suggesting adequate emotion regulation and empathy trainings as therapeutic targets for future interventions of opioid use disorders and long‐term pain treatment with opioids.

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慢性非医疗处方阿片类药物使用和对疼痛的同情：疼痛有区别吗？

非医疗处方阿片类药物使用 (NMPOU) 是美国阿片类药物流行的核心。尽管长期使用阿片类药物通常伴有社会功能缺陷，但人们对慢性 NMPOU 对社会认知功能的影响知之甚少。社会神经科学模型表明，同理心会激活与支持该情绪状态（例如疼痛）的第一手经验的神经结构相似甚至等效的神经结构。因此，我们测量了 23 名 NMPOU 患者在疼痛共情任务期间的主观和心理生理反应，通过头发和尿液测试客观证实，并将他们与 29 名未使用阿片类药物的健康对照进行比较。与对照组相比，NMPOU 个体在看到他人痛苦时表现出较低的其他相关和自我相关的不愉快评级。通过响应任务的连续差异均方根 (RMSSD) 评估的皮肤电导反应和心率变异性 (HRV) 未发现对照组和 NMPOU 组之间存在差异。然而，在 NMPOU 组中，RMSSD-HRV 与自我相关的不愉快和渴望呈强烈负相关。随后的中介分析显示 RMSSD-HRV 对自我相关的不愉快有总体影响，而没有渴望的中介。这表明，由高 RMSSD-HRV 指数化的更强的情绪调节可能对 NMPOU 个体而不是健康对照组对分享他人的痛苦有下调作用，这进一步伴随着评分降低 随后的中介分析显示 RMSSD-HRV 对自我相关的不愉快有总体影响，而没有渴望的中介。这表明，由高 RMSSD-HRV 指数化的更强的情绪调节可能对 NMPOU 个体而不是健康对照组对分享他人的痛苦有下调作用，这进一步伴随着评分降低 随后的中介分析显示 RMSSD-HRV 对自我相关的不愉快有总体影响，而没有渴望的中介。这表明，由高 RMSSD-HRV 指数化的更强的情绪调节可能对 NMPOU 个体而不是健康对照组对分享他人的痛苦有下调作用，这进一步伴随着评分降低个人痛苦和移情关注。这些结果有助于更好地了解慢性阿片类药物使用者的社会功能，表明适当的情绪调节和同理心训练作为未来阿片类药物使用障碍干预和阿片类药物长期疼痛治疗的治疗目标。