Impact of Transcranial Direct Current Stimulation (tDCS) on Ultra Rapid Opioid Detoxification (UROD) Outcome

Background: Persistence of post-detoxification problems in drug addiction is one of the disadvantages of the ultra-rapid opioid detoxification (UROD) method. Transcranial direct current stimulation (tDCS) has been introduced in experimental addiction treatment for some years. Results of pilot studies suggest that it might be a promising method for addiction treatment. Objectives: This study explores the adjunctive application of Transcranial direct current stimulation during treatment of opiate addiction with the ultra-rapid opioid detoxification approach. Methods: This double blind sham-controlled clinical trial was carried out on patients with substance abuse admitted to the Bahman clinic of Yazd in Iran (March to September- 2014). Forty participants were randomly allocated to treatment and control groups. Two sessions of transcranial direct current stimulation (real or sham) over dorsolateral prefrontal cortices (DLPFC) were applied accompanied by ultra-rapid opioid detoxification. Withdrawal symptoms and craving were assessed by the Drug Desire Questionnaire (DDQ) and Objective Opiate withdrawal scale (OOWS) prior to ultra-rapid opioid detoxification as well as for the 24- hour interval after ultra-rapid opioid detoxification. Results: Transcranial direct current stimulation optimized the opiate addiction treatment through craving and the withdrawal syndrome alleviation and. Conclusions: The results of the study indicate that prefrontal transcranial direct current stimulation may promote the efficacy of the ultra-rapid opioid detoxification method in opioid addiction.

Neural bases for attenuation of morphine withdrawal by Heantos-4: role of l-tetrahydropalmatine

Severe withdrawal symptoms triggered by cessation of long-term opioid use deter many individuals from seeking treatment. Opioid substitution and α2-adrenergic agonists are the current standard of pharmacotherapy for opioid use disorder in western medicine; however, each is associated with significant complications. Heantos-4 is a non-opioid botanical formulation used to facilitate opioid detoxification in Vietnam. While ongoing clinical use continues to validate its safety and effectiveness, a mechanism of action accounting for these promising effects remains to be specified. Here, we assess the effects of Heantos-4 in a rat model of morphine-dependence and present evidence that alleviation of naloxone-precipitated somatic withdrawal signs is related to an upregulation of mesolimbic dopamine activity and a consequent reversal of a hypodopaminergic state in the nucleus accumbens, a brain region implicated in opioid withdrawal. A central dopaminergic mechanism is further supported by the identification of l-tetrahydropalmatine as a key active ingredient in Heantos-4, which crosses the blood–brain barrier and shows a therapeutic efficacy comparable to its parent formulation in attenuating withdrawal signs. The anti-hypodopaminergic effects of l-tetrahydropalmatine may be related to antagonism of the dopamine autoreceptor, thus constituting a plausible mechanism contributing to the effectiveness of Heantos-4 in facilitating opioid detoxification.

Macrolide Antibiotic in Opioid Detoxification: A Serendipitous discovery?

Introduction: While receiving opioid detoxification treatment with standard Detoxification protocol, one patient was additionally prescribed Roxithromycin for his associated skin infection. Upon withdrawal of roxithromycin following improvement in skin infection, very next day same patient complained of heightened opioid withdrawal symptoms. These symptoms relieved again following reintroduction of Roxithromycin! Material And Method: It was a naturalistic study of 72 Opioid Dependent patients who received inpatient detoxification treatment at the Universal College of Medical Sciences, Bhairahawa, Nepal. A total of 16 patients received standard opioid detoxification protocol before the incidence of above mentioned patient. Subsequently, a total of 56 patients received Roxithromycin, in addition to the standard protocol, during their inpatient stay with a maximum for a period of 10 days. Necessary ethical clearance from the institute’s ethical clearance committee was taken before carrying out this trial. Duration of inpatient stay and follow-up pattern after discharge was taken as the objective assessment of the efficacy of Roxithromycin in reducing severity of withdrawal symptoms. All other treatment parameters were similar in two groups. Results: Two groups did not differ in most demographic and clinical variables compared. Opioid dependence patients who received Roxithromycin had significantly longer (t=2.5; p=0.01) voluntary hospitalization stay (10.6 days, SD=6.2) vis-à-vis patients who did not receive it (6.4 days, SD=3.9). They also reported significantly more number of follow-ups after discharge (Fisher’s Exact Test= 0.02). Conclusion: Roxithromycin, besides being an antibiotic, also possibly act as an anti-inflammatory and immune-modulatory agent by regulating leukocyte function.