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Treating Opioid Addiction with Deep Brain Stimulation

First such procedure in the U.S.

A surgeon has implanted electrodes in the brain of a patient suffering from severe opioid use disorder, hoping to cure the man’s in­trac­table craving for drugs.

The device, known as a deep brain stimulator, is designed to alter the function of circuits in the brain. It has been used with varying degrees of success in the treatment of Parkinson’s disease, dystonia, epilepsy, obsessive-compulsive disorder and even depression. It is seen as a last-resort therapy after the failure of standard care.

The patient, 33-year-old hotel worker Gerod Buckhalter, said he had been unable to remain sober for more than four months since the age of 15, despite trying a variety of medications and other inpatient and outpatient treatments. Buckhalter is the first of four people in a pilot program, which aims to demonstrate that the technique is safe so that a full-scale clinical trial can be conducted.

The surgical team opened a hole in Buckhalter’s skull about the size of a nickel, then inserted four wires into his nucleus accumbens, a part of the brain’s reward system that responds strongly to opioids. Except when the hole was being cut in his skull, Buckhalter was awake and providing feedback throughout the procedure.

By sending a pulsed current through the electrodes, doctors believe they can regulate an imbalance in Buckhalter’s reward circuitry. The intervention also may prevent his condition from worsening.

The wires run from the stimulator, about the size of a pocket watch, and a battery, which were implanted behind Buckhalter’s collarbone, to his brain. Using wireless technology, doctors will adjust the current going through the electrodes to provide more or less stimulation to the nucleus accumbens, depending on Buckhalter’s needs.

 “The exact mechanisms are not known,” said Ali Rezai, executive chairman of the West Virginia University Rockefeller Neuroscience Institute, who performed the procedure. But he says by modulating the reward circuit, which relies on a chemical messenger called dopamine, “you’re getting better control, so you’re not craving dopamine as much.”

About 180,000 people around the world have deep brain stimulators. Rezai’s effort is believed to be the first attempt to use deep brain stimulation on opioid use disorder in the United States. It is partly funded by the National Institute on Drug Abuse.

Nora Volkow, NIDA’s director, said she spoke with a handful of the patients who underwent the procedure in China and concluded that the surgery had potential. They told her that after the operation, they were no longer consumed by the need to acquire drugs and were able to pay attention to other things. “They reported more of an ability to engage, to feel interest in other things,” she said.

Source: The Washington Post, Nov. 6, 2019

 

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