Quantifying absolute glutamate concentrations in nucleus accumbens of prescription opioid addicts by using 1H MRS

Introduction: The diagnosis of psychoactive substance use disorders has been based primarily on descriptive, symptomatic checklist criteria. In opioid addiction, there are no objective biological indicators specific enough to guide diagnosis, monitor disease status, and evaluate efficacy of therapeutic interventions. Proton magnetic resonance spectroscopy (H-1 MRS) of the brain has potential to identify and quantify biomarkers for the diagnosis of opioid dependence. The purpose of this study was to detect the absolute glutamate concentration in the nucleus accumbens (NAc) of patients with prescription opioid dependence using H-1 MRS, and to analyze its clinical associations. Methods: Twenty patients with clinically diagnosed definitive prescription opioid dependent (mean age = 26.5 +/- 4.3 years) and 20 matched healthy controls (mean age = 26.1 +/- 3.8 years) participated in this study. Patients were evaluated with the Barratt Impulsiveness Scale (BIS-11), the Self-Rating Anxiety Scale (SAS), and the opiate Addiction Severity Inventory (ASI). We used point-resolved spectroscopy to quantify the absolute concentrations of metabolites (glutamate, choline, N-acetylaspartate, glutamine, creatine) within the NAc. The difference between metabolite levels of groups and Pearson's correlation between glutamate levels and psychometric scores in patients were analyzed statistically. Results: Glutamate concentrations in the NAc were significantly higher in prescription opiate addicts than in controls (t = 3.84, p =.001). None of the other metabolites differed significantly between the two groups (all ps >.05). The glutamate concentrations correlated positively with BIS-11 scores in prescription opiate addicts (r =.671, p =.001), but not with SAS score and ASI index. Conclusions: Glutamate levels in the NAc measured quantitatively with in vivo H-1 MRS could be used as a biomarker to evaluate disease condition in opioid-dependent patients.