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The aim of the current large\u2010scale psychophysiological investigation was to test whether patients with OUD had lower resting\u2010state high\u2010frequency heart rate variability (HF\u2010HRV) than those without OUD, controlling for sociodemographic and clinical confounds. Additionally, we tested whether HF\u2010HRV was associated with opioid craving in this population. Participants in this cross\u2010sectional study were 490 chronic pain patients (50.4% female) treated with long\u2010term opioid therapy. OUD diagnosis was determined by psychiatric interview. HF\u2010HRV was measured at resting baseline. We computed the association between OUD and resting\u2010state HF\u2010HRV, controlling for age, gender, race, pain severity, emotional distress and opioid dose. Opioid craving was measured with visual analogue scales to assess whether HF\u2010HRV was associated with craving. Results showed that resting HF\u2010HRV was significantly lower for patients with OUD than for those without OUD (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001, <jats:italic>d<\/jats:italic>\u2009=\u20090.36), indicating deficits in autonomic flexibility. OUD diagnosis (<jats:italic>p<\/jats:italic>\u2009=\u20090.002) and OUD severity (<jats:italic>p<\/jats:italic>\u2009=\u20090.03) were associated with lower HF\u2010HRV in regression models accounting for a range of confounders. Additionally, lower HF\u2010HRV was significantly (but weakly) correlated with heightened opioid craving (<jats:italic>r<\/jats:italic>\u2009=\u2009\u22120.166, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Overall, findings suggest that resting\u2010state HF\u2010HRV may serve as a valid biomarker of addiction among people on long\u2010term opioid therapy.<\/jats:p>","DOI":"10.1111\/adb.13230","type":"journal-article","created":{"date-parts":[[2022,9,5]],"date-time":"2022-09-05T05:03:58Z","timestamp":1662354238000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Association between opioid use disorder and blunted heart rate variability among opioid\u2010treated chronic pain patients"],"prefix":"10.1111","volume":"27","author":[{"given":"R. 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