A first of its kind clinical trial was completed last week at West Virginia University when a small device was successfully implanted in the brain of a 33-year-old man who has struggled with opioid and benzodiazepine abuse for more than a decade with multiple overdoses and relapses.
This is the first time in the U.S. that brain stimulation — DBS — has been used to help a person fight opioid addiction, WVU officials said.
The procedure, performed by neurosurgeon Ali Rezai, executive chair of Rockefeller Neuroscience Institute, involved implanting a Medtronic DBS device in the addiction and reward center of the brain through a coin-sized hole cut into the skull. Rezai said a stimulator and battery and four wires — the width of a human hair and powered by a battery — were implanted near the patient’s collarbone.
“Like a pacemaker,” Rezai said.
The patient, Gerod Buckhalter of Greene County, Pa., was awake during the seven-hour surgery, and was able to answer questions Rezai asked. Buckhalter, who has been battling opioid addiction since he was 15, is a patient of the addiction services at the WVU Medicine Chestnut Ridge Center.
“Addiction is a brain disease involving the reward centers in the brain,” Rezai said.
Through the use of very small electrodes, deep brain stimulation sends impulses into specific areas of the patient’s brain involved in creating addictions and self-control behaviors, according to news-medical.net.
The chip then provides information to medical personnel about real-time cravings. Doctors, in turn, will be able to manipulate those cravings by sending out counter impulses, helping them understand how brain waves change in cases of opioid addiction.
“Despite our best efforts using current, evidence-based treatment modalities, there exist a number of patients who simply don’t respond,” said James Berry, interim chair of the WVU Department of Behavioral Medicine and Psychiatry, in a statement.
“Some of these patients remain at very high risk for ongoing catastrophic health problems and even death. DBS could prove to be a valuable tool in our fight to keep people alive and well,” said Berry, who is also RNI’s director of Addiction Services.
DBS has been used for a number of years to treat disorders such as Parkinson’s disease, tremors, dystonia, epilepsy and obsessive-compulsive disorder.
The RNI clinical trial, funded through a grant from the National Institute on Drug Abuse, will involve three additional people, all suffering from opioid addiction. To be eligible, the patients must have failed standards of care across multiple levels of WVU Medicine’s comprehensive inpatient, residential and outpatient treatment programs, which includes medication, as well as psychological and social recovery.
The patients will have the same procedure at RNI during the next nine to 12 months, a WVU Medicine spokesperson said. Similar surgeries have been performed in China.
West Virginia has the highest age-adjusted rate of drug overdose deaths involving opioids at a rate of 49.6 deaths per 100,000 people in 2017, NIDA said. That statistic is more than double the rate in 2010 and is three times higher than the national rate, 14.6 deaths for 100,000 people. NIDA said the sharpest increase in opioid-related deaths in the state involved synthetic opioids, mainly fentanyl. Prescription opioid deaths dropped from 383 in 2014 to 304 in 2017, a 20% decline.
More than 36 million nationwide are still considered at risk for opioid addiction. A person can get addicted to opioids in five days, addiction specialists have said.
Symptoms of opioid withdrawal can include the inability to sleep, excessive sweating, anxiety, muscle aches, abdominal cramping and diarrhea, blurry vision, rapid heartbeat and high blood pressure. In many cases, the person going through withdrawal will relapse.
“Addiction is a brain disease involving the reward centers in the brain, and we need to explore new technologies, such as the use of DBS, to help those severely impacted by opioid use disorder,” Rezai said.
