Acupuncture-related techniques for the treatment of opiate addiction: a case of translational medicine

Abstract

Drug addiction is a chronic brain disorder characterized by withdrawal symptoms that occur during drug abstinence and a high tendency of relapse. Compared with the currently available pharmacological interventions, acupuncture therapy has the potential to help drug addicts stay away from drugs without major adverse side effects. It has taken decades of research to optimize the parameters of electrical acupoint stimulation for detoxification and for relapse prevention, as well as to establish a safe and easy procedure by which drug addicts can use it on themselves. The discovery that acupuncture can trigger the release of opioid substances from the brain in the 1970s provided the inspiration. Following this, basic research on animals made it possible to understand the mechanisms of action and establish the procedure for treating drug addictions. This article reviews the past, present, and foreseeable future regarding the use of acupuncture-related technique for the treatment of opiate addiction from the perspective of translational medicine.

Keywords

morphine / dependence / withdrawal / addiction / dynorphins / acupuncture / electroacupuncture / transcutaneous electrical acupoint stimulation (TEAS) / enkephalins / endorphins

References

[1] Liu ZM, Lv XX, Mu R. A national survey on the basic situation of drug abuse in China. Chin J Prev Treat Drug Abuse (Zhongguo Yao Wu Lan Yong Fang Zhi Za Zhi) 2002; 40: 27–30 (in Chinese)

[2] SAMSHA. Results from the 2007 National Survey on Drug Use and Health: National findings. Rockville, MD: Substance Abuse and Mental Health Services Administration, Office of Applied Studies. 2008.

[3] Kleber HD. Pharmacologic treatments for heroin and cocaine dependence. Am J Addict 2003; 12(Suppl 2): S5–S18

[4] Wen HL, Cheung SYC. Treatment of drug addiction by acupuncture and electrical stimulation. Asian Med J 1973; 9: 138–141

[5] Margolin A. Acupuncture for substance abuse. Curr Psychiatry Rep 2003; 5(5): 333–339

[6] Smith MO. Ear acupuncture protocol meets global needs. Hong Kong International Acupuncture Conference Jan 14–16, 2011. Abstract pp.58–59

[7] Research group of acupuncture anesthesia, Peking Medical College. Effect of acupunctrure on pain threshold of human skin. Chin Med J (Engl) 1973; (3): 151–157

[8] Research Group of Acupuncture Anesthesia, Peking Medical College.The role of some neurotransmitters of brain in acupuncture analgesia. Sci Sin 1974; 17: 112–130

[9] Zhang XT. Research on acupuncture, moxibustion and acupuncture anesthesia. Beijing: Science Press, 1986

[10] Mayor DF. How electroacupuncture works I. Observations from experimental and animal studies. In: Mayor DF. Electroacupuncture: a practical manual and resourses. Chapter 6. Chuchill Livingston: Elsevier, 2007: 59–76

[11] Han JS, Terenius L. Neurochemical basis of acupuncture analgesia. Annu Rev Pharmacol Toxicol 1982; 22(1): 193–220

[12] Mayer DJ, Price DD, Rafii A. Antagonism of acupuncture analgesia in man by the narcotic antagonist naloxone. Brain Res 1977; 121(2): 368–372

[13] Han JS. Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends Neurosci 2003; 26(1): 17–22

[14] Han JS, Zhang RL. Suppression of morphine abstinence syndrome by body electroacupuncture of different frequencies in rats. Drug Alcohol Depend 1993; 31(2): 169–175

[15] Wang JQ, Mao LM, Han JS. Comparison of the antinociceptive effects induced by electroacupuncture and transcutaneous electrical nerve stimulation in the rat. Int J Neurosci 1992; 65(1–4): 117–129

[16] Chen XH, Han JS. All three types of opioid receptors in the spinal cord are important for 2/15 Hz electroacupuncture analgesia. Eur J Pharmacol 1992; 211(2): 203–210

[17] Han JS, Wang Q. Mobilization of specific neuropeptides by peripheral stimulation of different frequencies. News Physiol Sci 1992; 7: 176–180

[18] Hamza MA, White PF, Ahmed HE, Ghoname EA. Effect of the frequency of transcutaneous electrical nerve stimulation on the postoperative opioid analgesic requirement and recovery profile. Anesthesiology 1999; 91(5): 1232–1238

[19] Cui CL, Wu LZ, Luo F. Acupuncture for the treatment of drug addiction. Neurochem Res 2008; 33 (10):2013–2022

[20] Wu LZ, Cui CL, Han JS. Han’s acupoint nerve stimualtor (HANS) on the heart rate of 75 patients during heroin withdrawal. Chin J Pain Med (Zhongguo Teng Tong Yi Xue Za Zhi) 1996; 2(2): 98–102 (in Chinese)

[21] Wu LZ, Cui CL, Han JS. Han's acupoint nerve stimulator for the treatment of opiate withdrawal syndrome. Chin J Pain Med (Zhongguo Teng Tong Yi Xue Za Zhi) 1995; 1(1): 30–35 (in Chinese)

[22] Wu LZ, Cui CL, Han JS. Treatment of heroin addicts by 4-channel Han's Acupoint Nerve Stimulator (HANS). J Beijing Med Univ (Beijing Yi Ke Da Xue Xue Bao) 1999; 31: 239–242 (in Chinese)

[23] Wu LZ, Cui CL, Han JS. Reduction of methadone dosage and relief of depression and anxiety by 2/100 Hz TENS for heroin detoxification. Chin J Drug Depend (Zhongguo Yao Wu Yi Lai Xing Za Zhi) 2001; 10: 124–126 (in Chinese)

[24] Sun BQ, Ye YG, Qing LJ. A survey and analysis on the causes of relapse to heroin after detoxification in 615 cases. Chin J Drug Depend (Zhongguo Yao Wu Yi Lai Xing Za Zhi) 2001; 10: 214–216 (in Chinese)

[25] Gossop M, Green L, Phillips G, Bradley B. Lapse, relapse and survival among opiate addicts after treatment. A prospective follow-up study. Br J Psychiatry 1989; 154(3): 348–353

[26] Ling W, Amass L, Shoptaw S, Annon JJ, Hillhouse M, Babcock D, Brigham G, Harrer J, Reid M, Muir J, Buchan B, Orr D, Woody G, Krejci J, Ziedonis D. A multi-center randomized trial of buprenorphine-naloxone versus clonidine for opioid detoxification: findings from the National Institute on Drug Abuse Clinical Trials Network. Addiction 2005; 100(8): 1090–1100

[27] Soyka M, Zingg C, Koller G, Kuefner H. Retention rate and substance use in methadone and buprenorphine maintenance therapy and predictors of outcome: results from a randomized study. Int J Neuropsychopharmacol 2008; 11(5): 641–653

[28] Bradley BP, Phillips G, Green L, Gossop M. Circumstances surrounding the initial lapse to opiate use following detoxification. Br J Psychiatry 1989; 154(3): 354–359

[29] Wang B, Zhang BG, Ge XC, Luo F, Han JS. Inhibition by peripheral electrical stimulation of the reinstatement of morphine-induced place preference in rats and drug craving in heroin addicts. J Peking Univ Health Sci (Beijing Da Xue Xue Bao Yi Xue Ban) 2003; 35(3): 241–247 (in Chinese)

[30] Han JS, Trachtenberg AI, Lowinson JH. Acupuncture. In: Lowinson JH, Ruiz P, Millman RB, Langrod JG. Substance abuse: a comprehensive textbook. 4th ed. Chapter 49. Philadelphia: Lippincott, 2005: 743–782

[31] Fang J, Ma D, Zhong J, Zhu B, Ding GH, Fu LM, Cui CL, Han JS. Prospective study of Han’s acupoint nerve stimulator for preventing relapse of detoxified heroin addicts. Natl Med J China (Zhonghua Yi Xue Za Zhi) 2010; 90(21): 1472–1476

[32] Wu LZ, Cui CL, Tian JB, Ji D, Han JS. Suppression of morphine withdrawal by electroacupuncture in rats: dynorphin and kappa-opioid receptor implicated. Brain Res 1999; 851(1–2): 290–296

[33] Cui CL, Wu LZ, Han JS. Spinal kappa-opioid system plays an important role in suppressing morphine withdrawal syndrome in the rat. Neurosci Lett 2000; 295(1–2): 45–48

[34] Han JS, Li SJ, Tang J. Tolerance to electroacupuncture and its cross tolerance to morphine. Neuropharmacology 1981; 20(6): 593–596

[35] Wang GB, Wu LZ, Yu P, Li YJ, Ping XJ, Cui CL. Multiple 100 Hz electroacupucture treatments produced cumulative efffect on the suppression of morphine withdrawal syndrome: central preprodynorphin mRNA and p-CREB implicated. Peptides 2011;32(4):713–721

[36] Chu NN, Xia W, Yu P, Hu L, Zhang R, Cui CL. Chronic morphine-induced neuronal morphological changes in the ventral tegmental area in rats are reversed by electroacupuncture treatment. Addict Biol 2008; 13(1): 47–51

[37] Hu L, Chu NN, Sun LL, Zhang R, Han JS, Cui CL. Electro acupuncture treatment reverses morphine-induced physiological changes in dopaminergic neurons within the ventral tegmental area. Addiction Biol 2009, 14:431–437

[38] Chu NN, Zuo YF, Meng L, Lee DYW, Han JS, Cui CL. Peripheral electrical stimulation reversed the cell size reduction and increased BDNF level in the ventral tegmental area in chronic morphine-treated rats. Brain Res 2007; 1182: 90–98

[39] Han JS. Cui CL, Wu LZ, Ma D. Neurophysiology of acupuncture and its implication on substance abuse. Hong Kong International Acupuncture Conference Jan 14–16, 2011. Abstract pp.60–61

[40] Meade CS, Lukas SE, McDonald LJ, Fitzmaurice GM, Eldridge JA, Merrill N, Weiss RD. A randomized trial of transcutaneous electric acupoint stimulation as adjunctive treatment for opioid detoxification. J Subst Abuse Treat 2010; 38(1): 12–21

[41] Markou A, Weiss F, Gold LH, Caine SB, Schulteis G, Koob GF. Animal models of drug craving. Psychopharmacology (Berl) 1993; 112(2–3): 163–182

[42] Wang B, Luo F, Xia YQ, Han JS. Peripheral electric stimulation inhibits morphine-induced place preference in rats. Neuroreport 2000; 11(5): 1017–1020

[43] Liang J, Ping XJ, Li YJ, Ma YY, Wu LZ, Han JS, Cui CL. Morphine induced conditioned place preference in rats is inhibited by electroacupuncrure at 2 Hz: Role of enkephalin in the nucleus accumbens. Neuropharmacology 2010; 58(1): 233–240

[44] Wang B, Luo F, Ge XC, Fu AH, Han JS. Effects of lesions of various brain areas on drug priming or footshock-induced reactivation of extinguished conditioned place preference. Brain Res 2002; 950(1–2): 1–9

[45] Shi XD, Ren W, Wang GB, Luo F, Han JS, Cui CL. Brain opioid-receptors are involved in mediating peripheral electric stimulation-induced inhibition of morphine conditioned place preference in rats. Brain Res 2003; 981(1–2): 23–29

[46] Chen JH, Liang J, Wang GB, Han JS, Cui CL. Repeated 2 Hz peripheral electrical stimulations suppress morphine-induced CPP and improve spatial memory ability in rats. Exp Neurol 2005; 194(2): 550–556

[47] Shi XD, Wang GB, Ma YY, Ren W, Luo F, Cui CL, Han JS. Repeated peripheral electrical stimulations suppress both morphine-induced CPP and reinstatement of extinguished CPP in rats: accelerated expression of PPE and PPD mRNA in NAc implicated. Brain Res Mol Brain Res 2004; 130(1–2): 124–133

[48] Koob GF, Sanna PP, Bloom FE. Neuroscience of addiction. Neuron 1998; 21(3): 467–476

[49] Wise RA. Brain reward circuitry: insights from unsensed incentives. Neuron 2002; 36(2): 229–240

[50] Di Chiara G, North RA. Neurobiology of opiate abuse. Trends Pharmacol Sci 1992; 13(5): 185–193

[51] Nestler EJ. Molecular basis of long-term plasticity underlying addiction. Nat Rev Neurosci 2001; 2(2): 119–128

[52] Ma YY, Shi XD, Han JS, Cui CL. Peripheral electrical stimulation-induced suppression of morphine-induced CCP in rats: a role for dopamine in the nucleus accumbens. Brain Res 2008; 1212: 63–70

[53] Tao PL, Liang KW, Sung WY, Wu YT, Huang EY. Nalbuphine is effective in decreasing the rewarding effect induced by morphine in rats. Drug Alcohol Depend 2006; 84(2): 175–181

[54] Zhong F, Wu LZ, Han JS. Suppression of cue-induced heroin craving and cue-reactivity by single-trial transcutaneous electrical nerve stimulation at 2 Hz. Addict Biol 2006; 11(2): 184–189

[55] Ren YH, Wang B, Luo F, Cui CL, Zheng JW, Han JS. Peripheral electric stimulation attenuates the expression of cocaine-induced place preference in rats. Brain Res 2002; 957(1): 129–135

RIGHTS & PERMISSIONS

Higher Education Press and Springer-Verlag Berlin Heidelberg