Acupuncture helps reduce opioid cravings in patients receiving methadone

Key takeaways:

• Overall, 62% of patients who underwent acupuncture had their methadone dose reduced by 20% or more.
• Acupuncture also reduced mean opioid craving scores compared with sham acupuncture.

Acupuncture was superior to sham acupuncture in reducing methadone doses and opioid cravings in patients undergoing treatment for opioid addiction, findings showed.

According to Liming Lu, MD, from the Guangzhou University of Chinese Medicine, and colleagues, methadone maintenance treatment (MMT) has been shown to decrease opioid use in patients with opioid use disorder (OUD), but “its adverse effects have also been widely reported, such as constipation, dizziness and debility.”

“Therefore, many MMT clients require or are experiencing methadone dose reduction,” they wrote in Annals of Internal Medicine. “However, during the process of tapering methadone dosage, MMT clients often have persistent withdrawal symptoms, such as anxiety, depression, insomnia and a heightened craving for opioids.”

The researchers conducted a randomized sham-controlled trial in which Chinese participants aged 65 years or older with OUD who had been using MTT for at least 6 weeks were assigned to either acupuncture (n = 60) or sham acupuncture (n = 58) three-times weekly for 8 weeks. Primary outcomes included reductions in methadone doses by 20% or more and opioid cravings, which Lu and colleagues measured with a 100-mm visual analogue scale (VAS).

At 8 weeks, 62% of patients who received acupuncture reduced their methadone dose by 20% or more compared with 29% those who received sham acupuncture (risk difference = 32%; 97.5% CI, 13-52).

Patients who received acupuncture also had a greater reduction in mean opioid craving VAS score vs. those who received sham acupuncture (mean difference = –11.7 mm VAS; 95% CI, –18.7 to –4.8 mm).

In addition, Lu and colleagues found that those who received acupuncture had a lower reduction in their Pittsburgh Sleep Quality Index score vs. those who received sham acupuncture (MD = –2.3; 95% CI, –3.4 to –1.2), which they noted is an important finding.

“[Some] have suggested that acupuncture could be a potential treatment of sleep disturbance during morphine withdrawal by producing a considerable increase in rapid eye movement sleep, non-rapid eye movement sleep, and total sleep time,” the researchers wrote.

Of note, investigators observed no serious adverse events and no differences between the groups when participants were asked about which acupuncture they received.

Regarding explanations behind the findings, “some researchers believe that the mechanism for acupuncture decreasing drug craving is an increase in the levels of endogenous opioids and hormones, such as endorphins, enkephalin, adrenalin, noradrenalin, serotonin, and dopamine, in the central nervous system and plasma,” Lu and colleagues wrote.

They concluded that future research is warranted “to measure long-term clinical outcomes and to determine how acupuncture can best be incorporated into a comprehensive substance misuse treatment program.”

Still, “we believe these findings support the consideration of acupuncture for methadone reduction for persons who are receiving MMT,” they added.