Non-invasive brain stimulation modalities for the treatment and prevention of opioid use disorder: a systematic review of the literature


© 2020, © 2020 Taylor & Francis Group, LLC. The U.S. is currently facing an unprecedented epidemic of opioid-related deaths. Despite the efficacy of the current treatments for opioid use disorder (OUD), including psychosocial interventions and medication-assisted therapy (MAT), many patients remain treatment-resistant and at high risk for overdose. A potential augmentation strategy includes the use of non-invasive brain stimulation (NIBS) techniques, such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and auricular vagus nerve stimulation (aVNS). These approaches may have therapeutic benefits by directly or indirectly modulating the neurocircuitry affected in OUD. In this review, we evaluate the available studies on NIBS in the context of OUD withdrawal and detoxification, maintenance, and cravings, while also considering analgesia and safety concerns. In the context of opioid withdrawal and detoxification, a percutaneous form of aVNS has positive results in open-label trials, but has not yet been tested against sham. No randomized studies have reported on the safety and efficacy of NIBS specifically for maintenance treatment in OUD. TMS and tDCS have demonstrated effects on cravings, although published studies were limited by small sample sizes. NIBS may play a role in reducing exposure to opioids and the risk of developing OUD, as demonstrated by studies using tDCS in an experimental pain condition and TMS in a post-operative setting. Overall, while the preliminary evidence and safety for NIBS in the prevention and treatment of OUD appears promising, further research is needed with larger sample sizes, placebo control, and objective biomarkers as outcome measures before strong conclusions can be drawn.





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Publication Info

Young, Jonathan R, Shayan A Smani, Nicholas A Mischel, Michael D Kritzer, Lawrence G Appelbaum and Ashwin A Patkar (2020). Non-invasive brain stimulation modalities for the treatment and prevention of opioid use disorder: a systematic review of the literature. Journal of Addictive Diseases. pp. 1–14. 10.1080/10550887.2020.1736756 Retrieved from

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Jonathan Young

Assistant Consulting Professor in the Department of Psychiatry and Behavioral Sciences

Jonathan Robert Young, MD is Assistant Consulting Professor at Duke Department of Psychiatry & Behavioral Sciences, and Staff Psychiatrist at Durham VA Health Care System, Treatment Refractory Disorders Clinic. He is a member of the Division of Behavioral Medicine & Neurosciences where he has served as an attending physician in the Duke electroconvulsive therapy (ECT) clinic. His research interests focus on clinical applications of non-invasive neuromodulation technologies such as repetitive transcranial magnetic stimulation (rTMS) for the treatment of psychiatric and substance use disorders. Currently, Dr. Young is developing a multimodal smoking cessation intervention for Veterans with posttraumatic stress disorder (PTSD) who smoke utilizing functional-connectivity magnetic resonance imaging (fc-MRI) to guide a personalized and accelerated rTMS course in addition to cognitive behavioral therapy (CBT) and nicotine replacement therapy (NRT).

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