Etomidate use disorder linked to altered craving circuits and cortical thinning

A case-control study published in BMC Medicine investigated cue-induced craving and cortical changes in etomidate use disorder. Researchers recruited right-handed men aged 18–45 years meeting DSM-5 criteria for the disorder and age-matched healthy male controls in Guangzhou, China, between June 2023 and October 2024. EEG and functional MRI assessed responses to drug cues in independent cohorts; dynamic causal modeling examined effective connectivity, and structural MRI assessed cortical thickness.

Participants with etomidate use disorder showed amplified frontocentral late positive potential amplitudes during drug-cue exposure, correlated with subjective craving. Functional MRI showed increased cue-related activation in the temporoparietal junction and ventrolateral prefrontal cortex. Modeling identified abnormal inhibitory modulation from the ventrolateral prefrontal cortex to the temporoparietal junction, with weaker inhibition associated with greater craving. Structural imaging showed widespread thinning across prefrontal, parietal, occipitotemporal and limbic regions.

The findings identify a circuit for further investigation, rather than an established neuromodulation treatment target. The case-control design cannot determine whether etomidate exposure caused the observed abnormalities, and the male-only population limits generalizability. Sample sizes, effect estimates and uncertainty measures were not provided in the supplied text. The study received Chinese public research funding, and the authors declared no competing interests.