Positive and Negative Reinforcing Effects of Opioids: The Opponent Process Theory From a Clinical Perspective
Sandra Comer (New York State Psychiatric Institute, Columbia University
B. F. Skinner Lecture Series Paper
Dr. Sandra Comer is Professor of Neurobiology in the Department of Psychiatry at Columbia University. She received her BS at Vanderbilt University and Ph.D. at the University of Michigan for her research on the effects of drugs using preclinical models. Dr. Comer is Director of the Opioid Laboratory in the Division on Substance Use Disorders and her current research focus is on the clinical testing of medications for treating opioid use disorder, methods to maximize the use of naloxone by opioid users, and evaluations of the comparative abuse liability of prescribed pain medications. Dr. Comer served as President of the College on Problems of Drug Dependence, the longest standing scholarly society in the U.S. devoted to research on substance use disorders, and currently is the Public Policy Officer for CPDD. Dr. Comer is a member of the Expert Advisory Panel on Drug Dependence for the World Health Organization and has over 160 publications on substance use disorders.
Over 92,000 drug-related overdose deaths, the majority of which were due to opioids, were reported in the U.S. in 2020 (https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm). This increase in opioid-related overdose deaths occurred despite the availability of several effective treatment medications. Both positive and negative reinforcing effects of opioids may underlie the initiation of opioid use and development and maintenance of opioid use disorder (OUD). Some investigators suggest that the negative reinforcing effects of opioids become more prominent with repeated use. Evidence for this position will be presented using clinical data from a variety of sources. While both processes appear to be supported by the data, the relative contribution of positive and negative reinforcing effects in maintaining opioid use is unclear. Additional research should be conducted to directly address this issue because it has relevance for the development of more effective pharmacotherapeutic and behavioral treatment strategies for OUD.