Opioid addicted patient has electrodes implanted in brain to curb cravings in first such clinical trial in US
To curb a man's craving for opioids, a surgeon inserted electrodes into the patient's brain, making it the first such case in the US.
The procedure, called deep brain stimulation (DBS), is already used to treat conditions such as Parkinson's disease, depression, obsessive-compulsive disorder, and epilepsy.
The first patient—a 33-year-old hotel worker named Gerod Buckhalter—had trouble remaining sober for more than four months since the age of 15.
The procedure is a large ditch effort in treating patients like Buckhalter, who have exhausted all other treatment options. "I am not advocating for deep brain stimulation as a first-line or a second-line [treatment]. It's for people who have failed everything because it is brain surgery." Ali Rezai, executive chairman of the West Virginia University Rockefeller Neuroscience Institute, who conducted the pilot study, told Washington Post.
Animal studies and anecdotal evidence among humans, who have had deep brain stimulation for other diseases, show the procedure could be helpful in curbing cravings for opioids, alcohol, nicotine, and cocaine, Linda J. Porrino, a professor of physiology and pharmacology at Wake Forest School of Medicine told Washington Post.
The treatment has been explored in China before. And when Nora Volkow, director at National Institute on Drug Abuse, spoke with a handful of patients who underwent the procedure in China, she found out the procedure could be effective. "They reported more of an ability to engage, to feel interested in other things. The brain's fixation on opioids may have been disrupted by the surgery," she explains to the Washington Post.
Steered by Rezai, the pilot study was done to test the safety of the procedure. It will be tested on three other patients, before initiating a larger clinical trial. Information regarding Buckhalter was released on Thursday.
Drug overdose deaths, including those involving opioids, continue to increase in the United States. Two out of three drug overdose deaths involve an opioid, according to CDC. Overdose deaths from opioids, including prescription opioids, heroin, and synthetic opioids (like fentanyl) have increased almost six times since 1999. Overdoses involving opioids killed more than 47,000 people in 2017, and 36% of those deaths involved prescription opioid, reports CDC.
After surgery, opioids are usually prescribed to patients to reduce the intensity of pain.
Addiction concerns in the late 1990s were quashed by pharmaceutical companies who reassured the medical community that patients would not become addicted to opioid pain relievers and healthcare providers began to prescribe them at greater rates. And later, with increased use, it became clear that these medications could indeed be highly addictive.
Addiction is a brain disease involving the reward centers in the brain, and we need to explore new technologies, such as the use of DBS, to help those severely impacted by opioid use disorder,' Dr Rezei told Washington Post.
To target the imbalanced reward system in the brain, the team drilled a hole in Buckhalter's skull about the size of a nickel and inserted four wires into his nucleus accumbens, a part of the brain's reward system that responds strongly to opioids.
The team believes that passing pulsed current through the electrodes can control the imbalance in Buckhalter's reward circuits. Further, doctors can adjust the amount of current going through the electrodes, depending on their needs.
But there could be side effects. According to Porrino, reports of side effects from the stimulation, including cognitive difficulties and forgetfulness. She adds that a controlled clinical trial is critical to advancing the use of this technology.