Opioid Misuse and Neural Responses to Social Rejection

Abstract

Opioid misuse is a costly public health issue that often develops in response to physical pain. However, the roles of social pain in opioid misuse and the neural mechanisms that convey its potential effects are largely uninvestigated. Twenty eight participants who reported recreational opioid misuse in the past 30 days completed a study in which they were socially accepted and then rejected while undergoing functional magnetic resonance imaging (fMRI). Participants who misused opioids displayed a typical pattern of neural reactivity to rejection across broad swaths of cortical and subcortical regions, though subjective reports of rejection-related threat were encoded in brain regions with dense concentrations of opioid receptors. Greater post-rejection cravings for opioids were linked to a deficit in ventromedial prefrontal cortex (VMPFC) activity during social acceptance. Compared to healthy controls, participants who misused opioids exhibited greater VMPFC activity during rejection. These findings suggest that people who misuse opioids have intact neural processing of rejection events and that the distress of these events may be contributed to by dysfunction in the opioid system. Further, opioid cravings may arise when these individuals do not adequately pair social acceptance with a neural ‘safety signal’.