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Should you recommend acupuncture to patients with substance use disorders.

Acupuncture is an ancient therapeutic tool known to be the core of traditional Chinese medicine. Two theories suggest positive outcomes in patients treated with acupuncture:

* The oxidative stress reduction theory states that a "large body of evidences demonstrated that acupuncture has [an] antioxidative effect in various diseases, but the exact mechanism remains unclear." (1)

* The neurophysiologies theory states that "acupuncture stimulation can facilitate the release of certain neuropeptides in the CNS, eliciting profound physiological effects and even activating self-healing mechanisms." (2)

For decades, acupuncture has been used for addiction management. Here we provide information on its utility for patients with substance use disorders.

Opioid use disorder. Multiple studies have looked at withdrawal, comorbid mood disorders, and its management with acupuncture alone or in combination with psychotherapy and/or opioid agonists. Studies from Asia reported good treatment outcomes but had low-method quality. (3) Western studies had superior method quality but found that acupuncture was no better than placebo as monotherapy. When acupuncture is combined with psychotherapy and an opioid agonist, treatment results are promising, showing faster taper of medications (methadone and buprenorphine/ naloxone) with fewer adverse effects.

Cocaine use disorder. Most studies had poor treatment outcomes of acupuncture over placebo and were of low quality. A number of small studies were promising and found that patients treated with acupuncture were most likely to have a negative urine drug screen. (3) Although acupuncture is widely used in the United States to treat cocaine dependence, evidence does not confirm its efficacy.

Tobacco use disorder. A small group of studies favored acupuncture for smoking cessation. (3) Other studies reported no benefit compared with placebo or neutral results. Some studies agreed that any intervention (acupuncture or sham acupuncture) with good results is better than no intervention at all.

Alcohol use disorder. Almost no advantage over placebo was found. Studies with significant findings were in small populations. (3)

Amphetamine, Cannabis, and other hallucinogen use disorders. Available data on stimulants were too limited to be relevant. No studies were found on Cannabis and hallucinogens.

Further studies are needed

There is a lack of conclusive, good quality studies supporting acupuncture's benefits in treating substance abuse. Acupuncture has been known to lack adverse effects other than those related to needle manipulation, which is dependent on the methods (depth of needle insertion, accurate anatomical location, angle, etc.). Because this treatment option is virtually side-effect free, inexpensive, with positive synergistic results, more high-method quality studies are needed to consider it for our patients.

Dr. Carrasco is a PGY-3 Psychiatry Resident, and Dr. Aggarwal is Program Director, Psychiatry Program, Rutgers New Jersey Medical School, Newark, New Jersey.

Disclosures

The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.

References

(1.) Zeng XH, Li QQ, Xu Q, et al. Acupuncture mechanism and redox equilibrium. Evid Based Complement Altemat Med. 2014;2014:483294. doi: 10.1155/2014/483294.

(2.) Bai L, Lao L. Neurobiological foundations of acupuncture: the relevance and future prospect based on neuroimaging evidence. Evid Based Complement Altemat Med. 20132013:812568. doi: 10.1155/2013/812568.

(3.) Boyuan Z, Yang C, Ke C, et al. Efficacy of acupuncture for psychological symptoms associated with opioid addiction: a systematic review and metaanalysis. Evid Based Complement Altemat Med. 2014;2014:313549. doi: 10.1155/2014/313549.
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Title Annotation:Pearls
Author:Carrasco, Danilo Been; Aggarwal, Rashi
Publication:Current Psychiatry
Geographic Code:1USA
Date:Jul 1, 2017
Words:553
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