Urgent need for improved management of opioid withdrawal

This is the second post in a series on non-medication approaches for alcohol and drug abuse. Opioid addiction is a public health crisis in the U.S. It is estimated that as many as 36 million Americans abuse prescription opioid pain medications and approximately 500,000 are addicted to heroin. Effectively managing withdrawal and detoxification is critical to successful discontinuation of heroin or prescription opioid pain medications. Individuals undergoing opioid detox are more likely to leave treatment prematurely when opioid withdrawal symptoms are not adequately managed. This post reviews research findings on neuroelectric therapy, an approach that employs weak electrical current to mitigate symptoms of opioid withdrawal. A future post will review the evidence for neuroelectric therapy in managing alcohol withdrawal.

How neuroelectric therapy works

The term neuroelectric therapy is used to describe Cranial electrotherapy stimulation (CES) and Transcranial neuroelectric stimulation (TES), two techniques that use weak electrical current to reduce symptoms of opiate withdrawal such as depressed mood, pain, agitation and insomnia. TES is widely used in Germany for the management of withdrawal symptoms. Both approaches involve the application of weak electrical current to specific points on the scalp or ears at regular intervals during acute withdrawal from opiates, alcohol or nicotine. CES typically uses a single frequency setting, 100Hz. In contrast, TES treatments use multiple pulse frequencies and wave forms to lessen symptoms of detoxification depending on the particular substance of abuse and the stage of withdrawal that is being managed. In contrast to conventional pharmacological approaches, micro-current stimulation offers the important advantage of avoiding the use of other potentially addictive narcotics when managing symptoms of opiate withdrawal.

The mechanism of action by which weak electrical current reduces symptoms of alcohol and opiate withdrawal involves stimulation of release of endogenous brain opioid peptides including endorphins, enkephalins and others, and may be similar to the biological mechanism underlying electro-acupuncture. A recent study suggests that weak electrical current may modulate the activity of the amygdala or other limbic brain regions reducing pain and unpleasant emotions frequently associated with opioid withdrawal (Miranda & Taca 2017).

Inconsistent research findings

After decades of research findings on the efficacy of neuroelectric therapy for managing opioid withdrawal are inconsistent.

While some studies report significant benefit, other studies report negative or equivocal findings. In one small, open retrospective pilot study, charts were reviewed for 73 adults who had been managed for acute opioid withdrawal using a non-invasive electrical nerve stimulator (Miranda & Taca 2017). Most patients reported rapid reduction in withdrawal symptoms following 20 minutes of treatment which were sustained on 5-day follow-up. Following treatment with the nerve stimulator the majority of patients were successfully transitioned to conventional medication assisted therapy.

The mechanism of action is believed to involve stimulation of the amygdala (or other limbic structures) resulting in lessening of both physical discomfort and dysphoria that frequently accompany opioid withdrawal. Findings of another small study suggest that individuals who receive micro-current stimulation and methadone have less severe withdrawal symptoms than individuals using methadone alone (Bakhshani 2008). A 2013 review of controlled and uncontrolled studies and case reports on neuro-electric therapy for found ‘generally poor’ evidence for this approach in reducing opioid withdrawal and craving (Lincolnshire Knowledge and Research Service 2013).

Bottom line: more research needed 

Neuroelectric therapy should be regarded as potentially efficacious but provisional non-medication therapy for managing opioid withdrawal. Inconsistent research findings may reflect methodological differences in study design, the small number of sham-controlled studies, small study sizes and the absence of standardized treatment protocols. Pending confirmation by large well-designed sham-controlled studies neuroelectric therapy may prove to be a practical and affordable non-medication treatment of opioid withdrawal.