Overview of substance abuse acupuncture treatment research

Effect of Acupuncture for Methadone Reduction : A Randomized Clinical Trial

BACKGROUND

Methadone maintenance treatment (MMT) is effective for managing opioid use disorder, but adverse effects mean that optimal therapy occurs with the lowest dose that controls opioid craving.

OBJECTIVE

To assess the efficacy of acupuncture versus sham acupuncture on methadone dose reduction.

DESIGN

Multicenter, 2-group, randomized, sham-controlled trial. (Chinese Clinical Trial Registry: ChiCTR2200058123).

SETTING

6 MMT clinics in China.

PARTICIPANTS

Adults aged 65 years or younger with opioid use disorder who attended clinic daily and had been using MMT for at least 6 weeks.

INTERVENTION

Acupuncture or sham acupuncture 3 times a week for 8 weeks.

MEASUREMENTS

The 2 primary outcomes were the proportion of participants who achieved a reduction in methadone dose of 20% or more compared with baseline and opioid craving, which was measured by the change from baseline on a 100-mm visual analogue scale (VAS).

RESULTS

Of 118 eligible participants, 60 were randomly assigned to acupuncture and 58 were randomly assigned to sham acupuncture (2 did not receive acupuncture). At week 8, more patients reduced their methadone dose 20% or more with acupuncture than with sham acupuncture (37 [62%] vs. 16 [29%]; risk difference, 32% [97.5% CI, 13% to 52%]; P < 0.001). In addition, acupuncture was more effective in decreasing opioid craving than sham acupuncture with a mean difference of -11.7 mm VAS (CI, -18.7 to -4.8 mm; P < 0.001). No serious adverse events occurred. There were no notable differences between study groups when participants were asked which type of acupuncture they received.

LIMITATION

Fixed acupuncture protocol limited personalization and only 12 weeks of follow-up after stopping acupuncture.

CONCLUSION

Eight weeks of acupuncture were superior to sham acupuncture in reducing methadone dose and decreasing opioid craving.

PRIMARY FUNDING SOURCE

National Natural Science Foundation of China.

Clinical and Economic Evaluation of Acupuncture for Opioid-Dependent Patients Receiving Methadone Maintenance Treatment: The Integrative Clinical Trial and Evidence-Based Data

Objective: From the health care and societal perspectives, this study aimed to evaluate the clinical and economic effects of acupuncture as an adjunctive therapy for patients receiving methadone maintenance treatment (MMT). Methods: We conducted a parallel-arm RCT in China in 2019. Patients were included who met the diagnostic criteria and receive MMT for more than 30 days. Patients were randomly assigned to the exposed group (acupuncture plus MMT) or control group (MMT) at a 1:1 ratio. Daily methadone dosage, drug cravings using the VAS score, and insomnia using the Pittsburgh Sleep Quality Index (PSQI) were chosen as the effectiveness indexes, and the quality-adjusted life years (QALYs) was chosen as the utility index. Results: Overall, 123 patients were included. The exposed group was significantly (P < 0.05) better than the control group in the improvement of daily methadone dosage (17.68 vs. 1.07), VAS (38.27 vs. 2.64), and PSQI (2.18 vs. 0.30). The QALY was 0.0784 (95%CI: 0.0761-0.0808) for the exposed group and 0.0762 (95%CI: 0.0738-0.0787) for the control group. The total cost of the exposed group (2869.50 CNY) was higher than the control group (2186.04 CNY). The ICER of daily methadone dosage (41.15), VAS (17.86), and PSQI (313.51) were shown to be economically efficient. While ICUR (310,663.64 CNY/QYLY) was higher than the cost suggested by WHO. Conclusion: Acupuncture as an adjuvant therapy for MMT patients realizes its cost-effectiveness by reducing the dosage of methadone, improving drug cravings, and alleviating insomnia. It helps to improve quality of life, but since its cost exceeds what society is willing to pay, further study is needed.

Effect of acupuncture for methadone maintenance treatment patients: study protocol of a randomized clinical trial

BACKGROUND

Opioid dependence is an increasing public health problem all over the world. Patients with opioid dependence have to receive methadone maintenance therapy (MMT) as replacement therapy for years or even for their entire life. Acupuncture as a kind of therapy has been used to treat substance dependence for many years. Jin's three-needle acupuncture (JTN), a type of acupuncture technique, has been applied to treat various diseases for several decades. However, JTN as an acupuncture technique has not been used to treat patients receiving MMT. Therefore, we designed a randomized controlled trial to evaluate the efficacy and safety of acupuncture as adjunctive therapy for patients receiving MMT.

METHODS/DESIGN

This study is a parallel-arm, randomized controlled trial that aims to evaluate the efficacy and safety of acupuncture as adjunctive therapy for patients receiving MMT. A total of 140 eligible participants who range in age from 18 to 60 years and fulfil the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V), for opiate dependence will be enrolled into this study. All eligible participants will be randomly assigned to the acupuncture group or routine group in a 1:1 allocation ratio. Participants who are enrolled in the acupuncture group will receive MMT and JTN treatment for 30 min per session. Meanwhile, those who are assigned to the routine arm will receive MMT only. All 18 sessions of JTN treatment will be delivered over 6 weeks (3 per week) and followed by a 4-week follow-up period. The primary outcome measure will be the visual analogue scale (VAS) for drug craving and the daily consumption of methadone (DCOM). Secondary outcome measures will include the urine test for opioid use, the 36-item Short Form Survey (SF-36), the Beck Anxiety Inventory (BAI), the Beck Depression Inventory II (BDI-II) and Pittsburgh sleep quality index (PSQI). VAS, DCOM, BAI, BDI-II and the urine test for opioid use will be evaluated at baseline, the second week, the fourth week, the sixth week and the tenth week. SF-36 and PSQI will be assessed at baseline, the fourth week, the sixth week and the tenth week.

DISCUSSION

The results of this trial will provide evidence on the efficacy and safety of acupuncture as adjunctive therapy for patients receiving MMT.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR1900026357 . Registered on 2 October 2019.

Clinical Efficacy of Acupuncture as an Adjunct to Methadone Treatment Services for Heroin Addicts: A Randomized Controlled Trial

Scant scientific evidence supports the efficacy of acupuncture in the treatment of opiate dependence. The purpose of this study was to examine the effectiveness of acupuncture for heroin addicts on methadone maintenance by measuring the daily consumption of methadone, variations in the 36-item Short Form Health Survey-36 (SF-36) and Pittsburgh Sleep Quality Index (PSQI) scores, and heroin craving. Sixty heroin addicts were randomly assigned to true acupuncture (electroacupuncture at the Hegu [LI4] and Zusanli [ST36] acupoints, as well as acupuncture at the Ear Shenmen) or sham acupuncture (minimal acupuncture at the Hegu and Zusanli acupoints without electrical stimulation and superficial acupuncture at the Ear Shenmen), twice weekly for 4 weeks. From week 2 onwards, the daily dose of methadone was reduced by a significantly greater amount with true acupuncture compared with sham acupuncture. True acupuncture was also associated with a greater improvement in sleep latency at follow-up. All adverse events were mild in severity. Acupuncture appears to be a useful adjunct to methadone maintenance therapy (MMT) in heroin addiction.

Methadone maintenance treatment versus methadone maintenance treatment plus auricular acupuncture: impacts on patient satisfaction and coping mechanism

This study intended to (1) describe the baseline patient satisfaction level and preferred coping strategies and (2) assess patient satisfaction and coping mechanisms pre- and postintervention. Patients on methadone maintenance treatment (MMT) in Terengganu, Malaysia, were randomized into either MMT or MMT plus auricular acupuncture (MMT + AA) groups. All received the standard MMT, while participants on MMT + AA underwent concurrent AA session thrice weekly for 2 months (each session = 30 minutes). Data analysis was carried out using SPSS 16.0, employing descriptive and nonparametric statistics. Participations were received from 97 eligible male patients (median age = 36.0 years; Malay = 97.9%). After screening for dropouts, only 69 patients were considered for subsequent analysis (MMT = 40; MMT + AA = 29). At preintervention, both groups did not differ significantly in the parameters investigated. During postintervention, no significant difference was detected for satisfaction level but coping-wise, substance use was significantly and frequently adopted by MMT + AA patients compared to MMT respondents (P < .05). On separate analysis, those who received MMT alone adopted active coping, venting, and self-blame significantly more frequently postintervention (P < .05). Nevertheless, no significant difference for coping styles of MMT + AA patients was exhibited over time (P >.05). The addition of AA therapy into the standard MMT treatment did not seem to influence patient satisfaction and their coping ways.

Auricular acupuncture for chemically dependent pregnant women: a randomized controlled trial of the NADA protocol

Background

The prevalence of maternal drug use during pregnancy in North America has been estimated to be as high as 6-10%. The consequences for the newborn include increased risk for perinatal mortality and ongoing physical, neurobehavioral, and psychosocial problems. Methadone is frequently used to wean women off street drugs but is implicated as a cause of adverse fetal/neonatal outcomes itself. The purpose of our study was to test the ability of maternal acupuncture treatment among mothers who use illicit drugs to reduce the frequency and severity of withdrawal symptoms among their newborns.

Methods

We randomly assigned chemically dependent pregnant women at BC Women’s Hospital in Vancouver, British Columbia to daily acupuncture treatments versus usual care. By necessity, neither our participants nor acupuncturists were blinded as to treatment allocation. Our primary outcome was days of neonatal morphine treatment for symptoms of neonatal withdrawal. Secondary neonatal outcomes included admission to a neonatal ICU and transfer to foster care.

Results

We randomized 50 women to acupuncture and 39 to standard care. When analyzed by randomized groups, we did not find benefit of acupuncture; the average length of treatment with morphine for newborns in the acupuncture group was 2.7 (6.3) compared to 2.8 (7.0) in the control group. Among newborns of women who were compliant with the acupuncture regime, we observed a reduction of 2.1 and 1.5 days in length of treatment for neonatal abstinence syndrome compared to the non-compliant and control groups, respectively. These differences were not statistically significant.

Conclusions

Acupuncture may be a safe and feasible treatment to assist mothers to reduce their dosage of methadone. Our results should encourage ongoing studies to test the ability of acupuncture to mitigate the severity of neonatal abstinence syndrome among their newborns.

Clinical Trial Registration

http://www.clinicaltrials.gov registry: W05-0041

A six-week acupoint stimulation intervention for quitting smoking

This study creates a six-week acupoint stimulation program for quitting smoking by conducting an experimental research design and then evaluating its effects. A total of 59 smokers, 28 +/- 7.6 years of mean age, volunteered to participate and were randomly assigned to the experimental or sham group. The current investigation administered anti-smoking acupoints to the experimental group for six weeks, whereas the sham group used sham acupoints for six weeks. Before and after the six-week intervention, the participants completed questionnaires and offered blood samples. This research collected data of demographic factors, serum cotinine, carbon monoxide exhalation, daily tobacco consumption, and quit smoking rate of participants before and after the six-week intervention. After the intervention, it showed no significant differences in the serum level of cotinine and carbon monoxide exhalation between the two groups. The quit rate in the experimental group was 13.3% and 13.7% in the sham group. However, daily tobacco consumption was 10 cigarettes in the experimental group and 11.21 cigarettes in the sham group. This experimental study used the sham group as the control, resulting in no statistically significant findings. Future studies need more evidence-based research on the exact effect or placebo effect of acupoint stimulation and the appropriate design for sham acupoint, to examine quitting effect using acupoint stimulation in adult smokers.

Acupuncture treatment for women with concurrent substance use and anxiety/depression: an effective alternative therapy?

This exploratory study evaluated the benefits of adding auricular acupuncture to a 21-day outpatient structured psychoeducational treatment program for women with concurrent substance use problems, anxiety, and depression. Women receiving acupuncture (n = 185) reported having reduced physiological cravings for substances, felt significantly less depressed, less anxious, and were better able to reflect on and resolve difficulties than women in the control group (n = 101). It was found that auricular acupuncture, as an adjunct therapy to a comprehensive psychoeducational treatment program for women with addictions, shows promise in being an effective, more viable treatment alternative to anxiolytics.

Efficacy of acupuncture for treating cocaine addiction: a review paper

Acupuncture is being used in more than three hundred treatment facilities for treating substance abuse including cocaine addiction. Previous review papers could not evaluate the role of acupuncture for treating cocaine addiction because of lack of clinical trials at the time. Since then, several important studies were conducted in the field. This paper reviews existing clinical trials using acupuncture to treat cocaine addiction. The existing evidence fails to document the benefit of acupuncture in treating cocaine addiction as the sole treatment. Further efforts to document the efficacy of the NADA protocol to treat cocaine addiction as the sole treatment should be re-evaluated. There is a limited amount of evidence showing possible benefits of acupuncture when used as an adjunctive therapy to complement existing substance abuse treatment program. Future efforts should concentrate on systematic studies investigating the role of acupuncture as an adjunctive treatment for cocaine addiction. In addition, more formative research exploring the efficacy of different types and protocols of acupuncture treatments for cocaine addiction should be thoroughly investigated.

Acupuncture for substance abuse treatment in the Downtown Eastside of Vancouver

In British Columbia, Canada, the City of Vancouver's notorious Downtown Eastside (DES) represents the poorest urban population in Canada. A prevalence rate of 30% for HIV and 90% for hepatitis C makes this a priority area for public-health interventions aimed at reducing the use of injected drugs. This study examined the utility of acupuncture treatment in reducing substance use in the marginalized, transient population. Acupuncture was offered on a voluntary, drop-in basis 5 days per week at two community agencies. During a 3-month period, the program generated 2,755 client visits. A reduction in overall use of substances (P=.01) was reported by subjects in addition to a decrease in intensity of withdrawal symptoms including "shakes," stomach cramps, hallucinations, "muddle-headedness," insomnia, muscle aches, nausea, sweating, heart palpitations, and feeling suicidal, P<.05. Acupuncture offered in the context of a community-based harm reduction model holds promise as an adjunct therapy for reduction of substance use.

Auricular Acupuncture in the Treatment of Cocaine/Crack Abuse: A Review of the Efficacy, the Use of the National Acupuncture Detoxification Association Protocol, and the Selection of Sham Points

BACKGROUND

The United Kingdom has had a significant increase in addiction to and use of cocaine among 16-29-year olds from 6% in 1998 to 10% in 2000. In 2000, the United Kingdom had the highest recorded consumption of "recent use" cocaine in Europe, with 3.3% of young adults. Acupuncture is quick, inexpensive, and relatively safe, and may establish itself as an important addiction service in the future.

AIM

To select investigations that meet the inclusion criteria and critically appraise them in order to answer the question: "Is acupuncture effective in the treatment of cocaine addiction?" The focus shall then be directed toward the use of the National Acupuncture Detoxification Association (NADA) protocol as the intervention and the selection of sham points for the control group.

DATA SOURCES

The ARRC database was accessed from Trina Ward (M. Phil. student) at Thames Valley University. AMED, MEDLINE and Embase were also accessed along with "hand" searching methods at the British Library.

INCLUSION AND EXCLUSION CRITERIA

People addicted to either cocaine or crack cocaine as their main addiction, needle-acupuncture, single-double-blinded process, randomized subjects, a reference group incorporating a form of sham points.

EXCLUSION CRITERIA

use of moxibustion, laser acupuncture, transcutaneous electrical nerve stimulation (TENS) electroacupuncture or conditions that did not meet the inclusion criteria.

QUALITY ASSESSMENT

The criteria set by ter Riet, Kleijnen and Knipschild (in 1990); Hammerschlag and Morris (in 1990); Koes, Bouter and van der Heijden (in 1995), were modified into one set of criteria consisting of 27 different values.

RESULTS

Six randomized controlled trials (RCTs) met the inclusion criteria and were included in this review. All studies scored over 60 points indicating a relatively adequate methodology quality. The mean was 75 and the standard deviation was 6.80. A linear regression analysis did not yield a statistically significant association (n = 6, p = 0.11).

CONCLUSIONS

This review could not confirm that acupuncture was an effective treatment for cocaine abuse. The NADA protocol of five treatment points still offers the acupuncturist the best possible combination of acupuncture points based upon Traditional Chinese Medicine. Throughout all the clinical trials reviewed, no side-effects of acupuncture were noted. This paper calls for the full set of 5 treatment points as laid out by the NADA to be included as the treatment intervention. Points on the helix, other than the liver yang points, should be selected as sham points for the control group.

Clinical research on acupuncture. Part 1. What have reviews of the efficacy and safety of acupuncture told us so far?

OVERVIEW AND METHODS: This paper discusses those medical conditions in which clinical trials of acupuncture have been conducted, and where meta-analyses or systematic reviews have been published. It focuses on the general conclusions of these reviews by further examining official reviews conducted in the United States, United Kingdom, Europe, and Canada each of which examined available systematic reviews. While all reviews agree that the methodological rigor of acupuncture clinical trials has generally been poor and that higher quality clinical trials are necessary, this has not completely hampered the interpretation of the results of these clinical trials. In some conditions the evidence of efficacy has clearly reached a sufficient critical mass from enough well-designed studies to draw clear conclusions; for the rest, the evidence is difficult to clearly interpret. This paper also examines conclusions from the same international reviews on the safety and adverse effects of acupuncture. Here, conclusions are more easily drawn and there is good agreement about the safety of acupuncture.

RESULTS AND CONCLUSIONS

General international agreement has emerged that acupuncture appears to be effective for postoperative dental pain, postoperative nausea and vomiting, and chemotherapy-related nausea and vomiting. For migraine, low-back pain, and temporomandibular disorders the results are considered positive by some and difficult to interpret by others. For a number of conditions such as fibromyalgia, osteoarthritis of the knee, and tennis elbow the evidence is considered promising, but more and better quality research is needed. For conditions such as chronic pain, neck pain, asthma, and drug addiction the evidence is considered inconclusive and difficult to interpret. For smoking cessation, tinnitus, and weight loss the evidence is usually regarded as negative. Reviews have concluded that while not free from serious adverse events, they are rare and that acupuncture is a relatively safe procedure.

Acupuncture: an evidence-based review of the clinical literature

This chapter reviews the experimental literature on the effects of acupuncture treatment. The review covers the 14 medical conditions for which the National Institutes of Health Acupuncture Consensus Development Panel (NIHCDP) concluded that acupuncture either is effective (2 conditions) or may be useful (12 conditions). My conclusions partially support those of the NIHCDP. There is evidence that acupuncture is effective for the treatment of postoperative and chemotherapy-induced nausea and vomiting. Also, some data indicate that acupuncture may be useful for headache, low back pain, alcohol dependence, and paralysis resulting from stroke (4 of the 12 conditions for which the NIHCDP found that acupuncture may be useful). For most of the remaining conditions, there is little evidence that acupuncture is either effective or ineffective. It is recommended that workers in the field design double blind, sham controlled trials using adequate acupuncture treatment regimens, with specific hypotheses, and sample sizes sufficient to allow both positive and negative conclusions.