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July 24, 2019

Time to Reconsider the Role of Craving in Opioid Use Disorder

Author Affiliations
  • 1School of Medicine and Dentistry, University of Rochester, Rochester, New York
  • 2McLean Hospital, Harvard Medical School, Belmont, Massachusetts
  • 3Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Psychiatry. 2019;76(11):1113-1114. doi:10.1001/jamapsychiatry.2019.1839

Craving has long been acknowledged by patients and clinicians as a significant feature of substance use disorders and especially opioid use disorder (OUD), as noted in a 2018 public meeting hosted by the US Food and Drug Administration (FDA).1 Craving is a subjective experience that can be unpredictable in its onset, variable in its intensity, and potentially overwhelming to a person when attempting to resist drug use.2,3 Patients may use a variety of terms besides or in addition to craving to describe this experience, such as having an urge, hunger, or desire to use a substance; this variability in terminology reflects some of the inherent difficulty in studying the concept (“I have really strong urges but no cravings”). Craving is not unique to drug use, and as anyone who has attempted to diet or abstain from a habit can attest, this phenomenon appears to be a part of human nature that can make changing an ingrained behavior pattern particularly problematic.

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