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Deep Brain Stimulation for Heroin Addiction: Possible New Treatment

Deep brain stimulation of the subthalamic nucleus (STN) has been shown to reduce heroin abuse in an animal model.

Interview with Olivier George, PhD

A new method for treating heroin addiction may be on the horizon.

Deep brain stimulation is becoming a treatment of interest to researchers for a variety of psychiatric conditions, including addiction. In a new study, researchers at The Scripps Research Institute in La Jolla, California, applied high-frequency stimulation (HFS) of the subthalamic nucleus (STN), a section of the brain now believed to be implicated in a variety of compulsive behaviors, to reduce heroid craving.1

According to lead author, Olivier George, PhD, from the Addiction Research Laboratory, the treatment could become a significant tool for treating heroin addiction in humans, especially considering the intervention already is being tested on people with other conditions, including cocaine addiction and obsessive compulsive disorder (OCD).

“All we need is to apply it to heroin addiction, which is in my opinion an ideal candidate considering the high morbidity associated with heroin use disorder,” Dr. George told Practical Pain Management. “The technology is there, the patients are there, the only real thing needed is money to put it together.”

Opioid addictionDeep brain stimulation may offer a new treatment option for people with opioid addiction.Opioid addiction is a major public health crisis, and heroin use has become a common illicit drug of choice for many Americans. In 2011, some 4.2 million people admitted they had tried heroin at some point in their lives, and for nearly a quarter of those people, their drug use evolved into an opioid use disorder.2

There are clinical methods for treating heroin addiction, including forms of cognitive behavioral therapy and drug counseling and medication-assisted treatments (MAT). But considering more than half of patients will relapse into heroin use within a year of their treatment and rehabilitation,3 the need for a better understanding of how compulsive drug behavior affects the brain is apparent, the authors stated.

Mapping the Brainwork of Heroin Addiction

Researchers have been exploring the use of brain stimulation as a potential treatment of addiction. There are currently 3 types of brain stimulation:

  • Transcranial magnetic stimulation (TMS)
  • Transcranial direct current stimulation (TDCS)
  • Deep brain stimulation (DBS)

The first 2 methods are noninvasive procedures that deliver a stimulus across the scalp and skull, where as deep brain stimulation reguires the implantation of electrodies in the brain.4

Deep brain stimulation5 is becoming a treatment of interest to researchers for a variety of psychiatric conditions, including addiction. However, much research up to this point has focused on just one part of the brain, the nucleus accumbens.6-8

“The same approach (using different parameters of stimulation) have been very successful for the treatment of compulsive behavior seen in patients with Parkinson’s disease.9-11 It is based on this success that people around the world have tried to use this approach for other disorders. Right now there are several clinical trials for cocaine addiction and OCD that are targeting the same brain region,” Dr. George said.

Could High Frequency Stimulation Alter Addictive Behavior?

Dr. George and his team prepared 32 male adult Wistar rats with intravenous catheters to deliver a transfusion of heroin (0.06 mg/kg/infusion) and implanted bilateral electrodes in the STN of the rats’ brains [(concentric bipolar stimulation microelectrode (DBS)].

Approximately half of the rats (control n = 9; DBS n = 11) were trained to self-administer the heroin in stable, daily 3-hour sessions, while the other half (control n = 8; DBS n = 8) self-administered heroin for 4 times longer every day. Not surprising, this latter group showed marked escalations in self-dosing of heroin.

After forcing the rats to abstain from administering heroin for 2 weeks, the researchers reintroduced access to the heroin. During this time, one group received HFS of the STN while the other did not.

The researchers found that regardless if rats were taking stable or escalating doses of the drug, stimulating the STN section of the brain appeared to make a positive difference, causing rats to self-administer less heroin than those that had not received the treatment.

Further study revealed the intervention appeared dose-dependent; for example,  a 2-day break from HFS STN treatment caused the rats to significantly increase heroin intake again.   

It appeared rats treated with HFS STN were less motivated to pull the lever to self-administer heroin, which could suggest the inhibition of impulsive behaviors. Ex vivo analysis found the intervention inhibited key parts of the brain, including the substantia nigra, the entopeduncular nucleus, and the nucleus accumbens shell.

According to Dr. George, these signs point to a novel therapeutic pathway by which doctors could better treat addictive behaviors, especially considering heroin users are at high risk of relapse once they finish rehabilitation and are back in an environment where they can choose to get access to drugs again.

But whether this form of treatment could translate to addictions for other substances is another question, altogether.

“Yes, it is possible that addiction to other drugs like alcohol or tobacco could benefit from such approach, but there is no clear evidence yet that it would work, and I am not sure that patients with alcohol and tobacco addiction would necessarily accept such treatments because it is associated with some risks due to the surgery,” Dr. George explained.

“However, I am convinced that many heroin addicts would go for it, because heroin addiction is associated with such a poor outcome, patients are miserable, they can lose everything, and are at high risk of overdose,” said Dr. George.

The study was supported by grants from the National Institutes of Health, the National Institute on Drug Abuse, and the Pearson Center for Alcoholism and Addiction Research. The authors declare no conflict of interest.

Last updated on: January 3, 2019
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