Does Acupuncture Work for Opioid Withdrawal?

The efficacy of acupuncture in the detoxification or drug withdrawal has been studied and approved worldwide by several clinical trials and scientific investigations. The possible mechanisms behind the therapy after several studies can be classified into two theories.1

The Endorphin Mechanism

What is the primary reason behind the development of withdrawal symptoms? Chronic use of opioids interferes with the brain opioid receptor sites. The combining of exogenous opioids at these receptor sites generates negative feedback where presynaptic neurons receive the message of standard transmission of endogenous opioids. This results in reduced synthesis of these neurotransmitters. On the inhibition of opioids, the body demands the opioid peptides, and during the time lag where the body regenerates the opioid supplementation, patient suffers from painful withdrawal symptoms.

Acupuncture stimulates endorphin production - the primary physiological basis for the therapeutic action of the therapy in the treatment of withdrawal symptoms and substance abuse. 

Other than the role of endorphins in the management of analgesia, the natural painkiller neurotransmitter inhibits the drug cravings and withdrawal symptoms. A person gets the feeling of wellbeing when his endorphin receptor sites become fulfilled by endogenous opioid peptides, i.e., endorphin & enkephalin. Substitution of endogenous opioids at receptor sites with opioid agonists such as morphine or heroin produces the same feeling of wellbeing. This wellbeing feeling forces the patient to continue the drug abuse. Therefore, increased release of endorphins due to acupuncture therapy inhibits the biological craving for addictive substances.[1]

The Reward Cascade

The genetics research scientist Kenneth Blum et al. (University of Texas Health Center San Antonio) proposed the “reward cascade” theory behind the effectiveness of acupuncture in opioid withdrawal. The therapy is related to the deficiency of the neurotransmitter dopamine in the limbic system of the brain. The system contains many centers that control basic life processes such as appetite, sexual desire, pleasure, satiety, emotional behavior, and drive. Therefore the limbic system plays a vital role in the reward system of the brain.

Acupuncture and the reward cascade- acupuncture helps in the treatment of withdrawal symptoms and substance abuse by increasing serotonin in the hypothalamus. It will normalize the disturbed functioning of the reward system and gives the feeling of wellbeing.[1]

Studies in Acupuncture for opiod withdrawl

A Meta-analysis of Acupuncture Combined With Opioid Receptor Agonists for Treatment of Opiate-Withdrawal Symptoms [2]

Study design: Randomized controlled trial (RCT) focused on opioid detoxification using a double-blind, single-blind, and nonblind design


Method: Participants (at least 15) suffering opiate dependence and going through acute stage of withdrawal symptoms were enrolled for the study. The trial consisted of two groups:

Experimental group treated with regimen of acupuncture plus opioid receptor agonists (AT plus ORA)

Control group treated with regimen of opioid receptor agonists (ORA) or partial opioid receptor agonists (pORA)

The results were measured in terms of total score for opiate-withdrawal symptoms, relapse rate, severity & frequency of side effects, or dosage strength needed for the treatment. Acupoints used for the therapy were neiguan, zusanli, shenmen, hegu, and sanyinjiao. The average electrical stimulation time period was 20-50 minutes with a frequency of once or twice a day. 

Results:

Total Withdrawal Symptoms Score (WSS): On a withdrawal symptom scale, the pretreatment baseline score (D0) was found to be similar among the two groups. But, scores on first (D1), seventh (D7), and the last two days (D9 and D10) showed significant improvement in combined treatment, i.e., AT plus ORA group.

Relapse rate: The 6-month relapse rate for the combined group vs control group was found to be as 87% vs 97%, 26.6% vs 56.8%, 29.0% vs 59.5%, and 28.3% vs 47.8% in the four trials respectively. Therefore, acupuncture can not be considered as an effective treatment for the prevention of relapse in addicted patients.

Safety of combined treatment (AT plus ORA): The frequency and severity of side effects in the experimental group were either the same or less than the control group of the consecutive four trials. The most common side effects reported were nausea, headache, vomiting, dry mouth, and blurred vision. Muscle twitching was another problem faced during electrostimulation, but it could be managed with the change in intensities. 

Medicine dosage needed: In three trials, the dosage for opioid agonists was made half in the combined group, and the withdrawal symptoms could be managed effectively in both groups. 

Discussion: The meta-analysis suggests that acupuncture therapy can be used in adjunct to opioid agonists for the treatment of withdrawal symptoms. The limitations of the study were quality of methodology, which suggests higher confirmation studies for the safety and requirement of medicine dosage for the use of acupuncture.[2]


Advancements in the Acupuncture for Opioid Alternative Treatment

The interest in acupuncture therapy for the treatment of withdrawal symptoms has been increasing diversely with the decades. Three prominent turnovers in the acupuncture can be described as:

a) Dr. Wen of Hong Kong was the first (1972) to report the use of electroacupuncture at four body points and two ear points in the treatment of opioid withdrawal symptoms.   

b) The second major step took place in 1985 by the findings of Dr. M. Smith in New York, the head of the National Acupuncture Detoxification Association (NADA) of the USA. He prepared a protocol for the treatment using only ears points without any electrical stimulation.

Recent advancements took place in 2005 with the research of Dr. Han of Peking University. He finalized a protocol for the treatment of drug abuse patients using electrical stimulation of identified frequencies on body points. The regimen focused on reducing the frequency & severity of withdrawal symptoms and the prevention of relapses in heroin users.3

Summary

The studies have confirmed the efficacy of acupuncture in opioid withdrawal. However, high-quality studies are still needed to verify the safety of the therapy. Though side effects are minimal with the use of acupuncture and can be managed, recommended proof of the safety of the treatment is still required. The scientists have also revealed the possible mechanisms behind the therapeutic action of the therapy. Among the several hypotheses, the endorphin mechanism and reward cascade theories are widely accepted.

References

1. Scott, S., & Scott, W. (1997). A Biochemical Hypotheses for the Effectiveness of Acupuncture in the Treatment of Substance Abuse: Acupuncture and the Reward Cascade. American Journal of Acupuncture-Paper Edition, 25(1), 33-38.

2. Liu, T. T., Shi, J., Epstein, D. H., Bao, Y. P., & Lu, L. (2009). A meta-analysis of acupuncture combined with opioid receptor agonists for treatment of opiate-withdrawal symptoms. Cellular and molecular neurobiology, 29(4), 449-454.

3. Cui, C. L., Wu, L. Z., & Luo, F. (2008). Acupuncture for the treatment of drug addiction. Neurochemical research, 33(10), 2013-2022.


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