Brain mu-opioid receptor binding: Relationship to relapse to cocaine use after monitored abstinence

Rationale: Cocaine users have increased regional brain mu-opioid receptor (mOR) binding which correlates with cocaine craving. The relationship of mOR binding to relapse is unknown. Objective: To evaluate regional brain mOR binding as a predictor of relapse to cocaine use is the objective of the study. Materials and methods: Fifteen nontreatment-seeking, adult cocaine users were housed on a closed research ward for 12 weeks of monitored abstinence and then followed for up to 1 year after discharge. Regional brain mOR binding was measured after 1 and 12 weeks using positron emission tomography (PET) with [¹¹C]carfentanil (a selective mOR agonist). Time to first cocaine use (lapse) and to first two consecutive days of cocaine use (relapse) after discharge was based on self-report and urine toxicology. Results: A shorter interval before relapse was associated with increased mOR binding in frontal and temporal cortical regions at 1 and 12 weeks of abstinence (Ps<0.001) and with a lesser decrease in binding between 1 and 12 weeks (Ps<0.0008). There were significant positive correlations between mOR binding at 12 weeks and percent days of cocaine use during first month after relapse (Ps<0.002). In multiple linear regression analysis, mOR binding contributed significantly to the prediction of time to relapse (R ²=0.79, P<0.001), even after accounting for clinical variables. Conclusions: Increased brain mOR binding in frontal and temporal cortical regions is a significant independent predictor of time to relapse to cocaine use, suggesting an important role for the brain endogenous opioid system in cocaine addiction.