Deep brain stimulation can ease opioid addiction when other treatments fail

As James Fisher waited for an experimental brain surgery he recently had, he wondered if this would be the treatment that would finally help him get his addiction under control.

The tiny electrodes implanted by surgeons into his brain’s reward center are designed to deliver electrical stimulation that could, in theory, help quell the constant urge he feels for benzodiazepines, his drug of choice.

Fisher, 36, who lives in West Virginia, is the third patient enrolled in a clinical trial at the Rockefeller Neuroscience Institute at the University of West Virginia. To be included in the study, which uses a technique called deep brain stimulation, patients must have undergone extensive rehabilitation efforts that did not work and suffered multiple overdoses.

At first, Fisher, a drug addict since high school, easily found doctors willing to write prescriptions for his social anxiety. When it stopped working, he started buying from friends and eventually started robbing strangers to get the money to pay for the drugs. Initially it was just “benzos,” but later he switched to prescription opioids and then to heroin.

After four nearly fatal overdoses, he jumped at the chance to participate in the trial.

“I don’t want to die,” Fisher told NBC News before the operation. “I don’t want to live this miserable life of being sober and always wanting something and not being able to get it.”

As part of an NBC News “One Nation Overdosed” series, “Nightly News with Lester Holt” gained access to the University of West Virginia experimental trial as surgeons implanted wires into the brain of Fisher to treat his severe opioid use disorder.

In the University of West Virginia’s drug addiction trial, tiny electrodes are implanted in a part of the brain that has evolved to reward behaviors such as foraging and sex. W. Virginia University

Deep Brain Stimulation (DBS) has been used successfully for decades to treat symptoms of Parkinson’s disease. Doctors at the Rockefeller Neuroscience Institute developed the worst-case addiction technique on the theory that targeting one of the brain’s reward centers – the nucleus accumbens – with tiny sparks of electricity could quell potent cravings. , allowing regions of the brain involved in judgment and decision-making to be heard, said lead researcher Dr Ali Rezai, executive chairman of the Morgantown institute.

Drugs such as benzodiazepines and opioids hijack the reward system and once users are exposed they need more and more substances to get the feel-good neurotransmitter dopamine surge.

“Our hypothesis was that by using DBS in this part of the brain, we would essentially normalize dopamine levels,” Rezai said. “In addiction, the reward part of the brain releases dopamine when the drugs are taken and people feel good. And then they want more next time to have the same feeling. “

For patients with Parkinson’s disease, electrodes are implanted in the parts of the brain involved in movement. In the drug addiction trial, the electrodes are implanted in another part of the brain, an area that has evolved to reward behaviors that keep the species alive, such as foraging and sex. Dopamine is released when these goals are met, as well as at times when people experience natural beauty, such as a particularly colorful sunset or a moving piece of music.

When the electrode implantation operation is complete, the doctors turn on the deep brain stimulation device. For Fisher, the results were immediate and surprising. Depression, anxiety and irritability disappeared, replaced by a feeling of calm and comfort, like “a warm blanket”.

“It’s like night and day,” he said.

Fisher’s operation took place at the end of July. After four weeks, he told NBC News he felt “fantastic” without having the urge to use drugs.

Two months later, he’s still sober.

“I’m ready to do whatever it takes to get my brain back to normal,” Fisher said. “I hope I can go back to this period before I start using benzos. Just being naturally happy – enjoying the music again, enjoying the food again, enjoying seeing a smile on someone’s face.

“I’m ready to do whatever it takes to get my brain back to normal,” said James Fisher before the experimental treatment for his opioid addiction. NBC News

The initial phase of the trial, which began with the first patient in 2019, is designed to test the safety of the treatment and will eventually include four people with severe substance use disorders. A second phase with 10 patients will test its effectiveness in preventing people from using drugs.

The need for additional treatment for opioid dependence is urgent. In 2020, during the pandemic, drug overdose deaths reached record highs of more than 93,000, according to data from the Centers for Disease Control and Prevention. Synthetic opioids, including fentanyl, were responsible for 60% of deaths.

According to the Substance Abuse and Mental Health Services Administration, 18.9 million people aged 12 or older in 2019 suffered from a substance use disorder and 16.3 million misused prescription drugs.

According to the experience of Gerod Buckhalter, the first patient to undergo surgery at the institute, Fisher’s chances of staying sober for a long time are good.

Buckhalter, 35, became addicted to prescription opioids after a shoulder injury at age 15. Despite many stints in rehab and frightening overdoses, he was unable to shake off his addiction. He immediately signed up when offered the chance to be the first patient in the trial.

After the electrodes were implanted, the researchers turned on the device. The effect was dramatic.

“I didn’t find the joy of living,” recalls Buckhalter. “When they turned it on, of course, I didn’t know what was going to happen in the future, but at that moment I knew that if I could continue to feel what I was feeling at that moment, everything would be fine. . “

He says he hasn’t used it even once in two years. He is still in therapy and is taking Suboxone, a compound drug designed to fight opioid addiction. But staying away from opioids is much easier after surgery.

Buckhalter’s recovery from the 2019 brain stimulation procedure was first reported by The Washington Post in June.

Experts warn that the results are preliminary and do not constitute a guaranteed cure. Of the three initial patients, one relapsed and is no longer in the trial. Even though the institute’s trial shows it can help some incurable addicts, wider use is still years away.

“There is a lot of research where there have been positive results initially and then they are not found to be as reproducible,” said Dr W. Jeffrey Elias, professor of neurological surgery at the Brain Institute of the United States. ‘University of Virginia. Even so, he says the concept and the early discoveries are exciting.

“We understand more and more of the brain circuitry, especially with reward and addiction issues, so we have very specific tools to target the brain,” he said.

Dr. Ausaf Bari, assistant professor and director of functional and restorative neurosurgery at UCLA’s David Geffen School of Medicine, likens the device to a pacemaker.

“One of the things people try to use DBS for is to specifically alter the brain circuits involved in craving and relapse,” he said. “Just like a pacemaker treats abnormal rhythms in the heart, we can use DBS to correct abnormal rhythms in the brain.”

In future studies, researchers may need to individualize the exact places they use DBS to target, Bari said. Triggering different parts of the brain can produce different responses. Until researchers and patients try it, they won’t know how to get the most effective response, he said.

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