Authors Molly Carlyle1*, Malin Kvande*, Isabell M. Meier, Martin Trøstheim, Kaja Buen, Eira Nordeng Jensen, Gernot Ernst, Siri Leknes, Marie Eikemo (*denotes equal contribution)Please use the format "First name initials family name" as in "Marie S. Curie, Niels H. D. Bohr, Albert Einstein, John R. R. Tolkien, Donna T. Strickland"
Abstract <p><strong>Introduction</strong>: Opioid analgesic treatment during surgery entails risk of persistent use. Experiences of childhood adversity have been shown to increase opioid reward in preclinical models, a finding recently extended to healthy humans. We tested whether childhood adversity similarly increased opioid reward, operationalised as drug-induced feeling good and drug liking, in outpatients receiving opioids on the operating table. </p>
<p><strong>Methods</strong>: This observational study recruited patients entering a Norwegian hospital for an outpatient surgical procedure. An opioid intravenous opioid analgesic (remifentanil [Minto model, effect site concentration: 5ng/ml], or oxycodone [5mg]) was administered in the minutes before general anaesthesia. Verbal numerical ratings of feeling good and anxious were collected 1 minute before, and 1-3 minutes after opioid infusion. Ratings of drug liking, disliking, and feeling high were also collected after infusion. Patients (n = 151) completed measures of childhood adversity at a later date.</p>
<p><strong>Results</strong>: Regression analyses revealed a modest yet significant negative association between childhood adversity and post-opioid liking (b = -0.06, p = 0.046) but no significant effect on feeling good (b = 0.01, p = 0.690) after the pre-operative opioid dose. Exploratory analyses showed that more childhood adversity was significantly associated with higher reports of anxiety, depression, loneliness, and pain catastrophising, however not with alcohol or other drug use, or with any other subjective drug effects.</p>
<p><strong>Discussion</strong>: Ratings of feeling good and drug liking of medically prescribed opioids given before surgery were not higher after childhood adversity, and previous findings were not conceptually replicated. The discrepancy between current and prior results may be due to the context and stress related to the impending surgery, the short duration of drug exposure, and the relatively limited levels of high childhood adversity in the current sample compared to the original study. Exploratory analysis was consistent with the possibility of a nonlinear relationship between positive opioid effects and childhood adversity scores. Future research should assess the link between childhood adversity, subjective effects, and use of the prescribed opioids after surgery. </p>
