40| The Effect of Opioid Use and Treatment on Cognition – A Conversation With Dr. Monica Rivera Mindt

We brought Monica Rivera Mindt, Ph.D., ABPP-CN, back on the podcast to discuss the cognitive effects of opioid use (both licit and illicit).  We discuss the history of the opioid epidemic in the U.S., the neurobiology of opioids, and common treatments for opioid use disorder.  Visit the post for episode 21 to read Monica’s bio and listen to our conversation with her about cultural neuropsychology.

A pdf of the transcript for this episode is available here.

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Show notes (with time stamps)


  • We discuss two upcoming projects, Neuropsych Bites and our book, Becoming a Neuropsychologist (00:36)
  • We define terminology (2:49)
  • Risk of opioid use disorder for treatment of chronic pain (3:03)
  • Incidence of opioid use disorder in the U.S. (3:27)
  • Opioid mortality rates (4:37)
  • Center for Disease Control and Prevention (CDC) guidelines for prescribing opioids for chronic pain (5:59)
  • DSM-V criteria for opioid use disorder (7:29)

Interview with Dr. Monica Rivera Mindt

  • Historical context of the opioid epidemic (10:52)
  • Fentanyl use (14:17)
  • At-risk populations for opioid use (15:22)
  • Highest overdose rates in the U.S. are in the Appalachia mountain range (15:58)
  • Mesolimbic reward pathway (16:28)
  • Other neuroanatomical structures implicated in opioid use (18:41 and 37:50)
  • The reason opioids are more addictive than stimulants, despite both drugs being involved in the same reward system (19:29)
  • Common pathways to addiction and opioid use disorder (20:46)
  • Harm reduction interventions for opioid use (25:02)
  • Mechanisms for three types of pharmacological treatments for opioid use – opioid agonist, opioid partial agonist, and opioid antagonist (27:12)
  • Duration of maintenance therapies (30:10)
  • The effects of maintenance therapies on cognition (33:03)
  • Whether drug use causes cognitive deficits or whether individuals with cognitive deficits have a higher risk of using drugs (37:02)
  • Dose-dependent relationship of opioid use and cognitive deficits (39:22)
  • Whether illicit or licit drugs have different effects on cognition (52:41)
  • Opioid use and risk for polysubstance use (40:36)
  • Role of a clinical neuropsychologist in the opioid epidemic (43:22 and 48:41)
  • The appropriate time to test individuals who are currently using opioids (47:10)
  • The significance of clinical neuropsychologists collaborating with other healthcare professionals (48:01)
  • Cognitive interventions for individuals who are using opioids (53:22)
  • Monica recommends the harm reduction approach to treating opioid use disorder (55:46)

Selected References

Arias, F., Arnsten, J. H., Cunningham, C. O., Coulehan, K., Batchelder, A., Brisbane, M., et al. (2016). Neurocognitive, psychiatric, and substance use characteristics in opioid dependent adults. Addict Behav, 60, 137-143.

Baldacchino, A., Balfour, D. J., Passetti, F., Humphris, G., & Matthews, K. (2012). Neuropsychological consequences of chronic opioid use: a quantitative review and meta-analysis. Neurosci Biobehav Rev, 36(9), 2056-2068.

Dowell, D., Haegerich, T. M., & Chou, R. (2016). CDC Guideline for Prescribing Opioids for Chronic Pain–United States, 2016. JAMA, 315(15), 1624-1645.

Kiang, M. V., Basu, S., Chen, J., & Alexander, M. J. (2019). Assessment of Changes in the Geographical Distribution of Opioid-Related Mortality Across the United States by Opioid Type, 1999-2016. JAMA Netw Open, 2(2), e190040.

NIDA. (2020). Opioid Overdose Crisis. Retrieved March 15, 2020, from https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis

Scott, T. M., Rivera Mindt, M., Cunningham, C. O., Arias, F., Coulehan, K., Mangalonzo, A., et al. (2017). Neuropsychological function is improved among opioid dependent adults who adhere to opiate agonist treatment with buprenorphine-naloxone: a preliminary study. Subst Abuse Treat Prev Policy, 12(1), 48.

Stone, K., & Shirley-Beavan, S. Global state of harm reduction 2018. Londol: Harm Reduction International; 2018.

Tinker, B. (2019). These States Have Been Hit the Hardest by America’s Opioid Epidemic. Retrieved March 15, 2020, from https://www.cnn.com/2019/02/22/health/opioid-deaths-states-study/index.html