Sunsha CHAMAKALAYIL, Serge BRAND, Marc VOGEL, Markus GERBER, Kenneth M. DÜRSTELER
Alpha Psychiatry - 2026;27(2):45138-0
Background: Severe opioid dependence is associated with neurocognitive impairments, potentially aggravated by recurrent overdose-induced hypoxia and long-term opioid use-induced hypoperfusion. Although hypoxia-related impairments seem to vary with severity, duration, and frequency, findings are inconsistent. Moreover, evidence specific to opioid-related hypoxia is scarce. Given this gap, this prospective pilot study examined whether hypoxic incidents predict poorer neurocognitive performance and reduced improvement during three months of opioid agonist treatment. Methods: Forty-seven individuals with opioid dependence (mean age = 34.3 years; 27.7% female) completed a neuropsychological assessment that included 12 validated tests covering a broad range of neurocognitive domains at baseline and at study end (n = 33; 33% female). Results: The repeated-measures ANOVA yielded no significant effects of Time, Group (hypoxic incidents vs. no hypoxic incidents), or their interaction on neurocognitive performance in the domains of attention, memory, or executive functions. This suggests that changes in neurocognitive performance over time did not differ significantly between participants with and without a history of hypoxic incidents. However, post-hoc analyses indicated that hypoxic incidents requiring resuscitation may adversely affect neurocognitive functioning. Conclusions: These findings suggest that hypoxic incidents without resuscitation may not aggravate long-term neurocognitive impairments, supporting previous findings that brain cells can tolerate transient hypoxia. These results may also suggest that treatment planning should prioritize history of resuscitation incidents along with other prognostic factors such as duration of opioid use, baseline neurocognitive impairments, co-occurring mental health conditions, and socioeconomic factors. Future studies with larger samples and more precise assessments of hypoxia are essential to further clarify these findings and optimize treatment approaches.
