Pepper Center - UF Institute on Aging
10/1/20 - 9/30/22
Meredith S. Berry, PhD (University of Florida); Danielle E. Jake Schoffman, PhD (University of Florida) (Multiple PIs)
Other Project Staff
Jesse Dallery, PhD (Co-I); Demetra Christou, PhD (Co-I )
Opioid abuse is a major source of morbidity and mortality in the U.S. and represents an urgent public health crisis. From 2002 to 2017 in the U.S. alone, deaths from opioids have more than quadrupled, and more than 100,000 people begin opioid maintenance treatment (OMT) annually. Although OMT is the standard care for opioid use disorder (OUD), patients continue to experience high levels of pain, heightened sensitivity to pain, loss of mobility, weight gain, and recurrent relapse to harmful opioid abuse that has been directly associated with OMT medications. Critically, pain, illicit substance seeking, craving and withdrawal, are interactive, and constitute significant predictors of lack of adherence to OMT and relapse. In recent years, a surge of adults over the age of 50 have developed opioid use disorder, a significant and alarming trend that is increasing. There is an urgent need to develop treatments that preserve the benefits of OMT for older adults, and simultaneously diminish pain, enhance mobility, and decrease continued craving and withdrawal symptoms. Currently, no established adjunctive OMT treatment target pain and mobility, and craving and withdrawal. A promising adjunct treatment option for OUD is the addition of a supervised aerobic exercise program to OMT. In older adults, aerobic exercise significantly reduces inflammatory markers, helps relieve pain and increase mobility, and is important for preserving physical function and mobility, as well as delaying onset of major disability. Animal models of human drug addiction show exercise stimulates the release of endogenous opioid peptides, and reduces intravenous self-administration of heroin and morphine relative to control groups. It also attenuates the severity of physical dependence, anxiety, and morphine consumption in morphine withdrawn rats receiving OMT. Although exercise treatment for OUD is persuasive in theory with strong preclinical support, no sustained fully powered clinical trials have assessed its effectiveness or mechanistic underpinnings. Despite this, initial evidence for short-term exercise in OMT patients demonstrates reasonable adherence and brief lab studies show craving reductions in other substance use populations. Based on this evidence, this line of research aims to test the effectiveness of a supervised aerobic exercise program for OMT patients 50-75 years of age. We will determine the effects of the exercise intervention versus control on (i) self-reported pain and pain catastrophizing, (ii) objective and self-reported mobility ratings (iii) biologically verified urinalysis results of illicit drug-use, and (iv) craving, withdrawal, and behavioral economic demand for opioids. This study directly aligns with the central OAIC themes of enhancing mobility, and reducing pain through an exercise intervention. This study has tremendous potential for public health impact with possibility for wide deployment for those in need. Our multidisciplinary team is uniquely suited to advance understanding of shared mechanisms underlying pain, mobility, craving and withdrawal, and to complete the proposed project with expertise in (i) OUD (ii) PA promotion (iii) pain (iv) exercise physiology (v) cardiology and (vi) biostatistics.