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TRADING NEEDLES FOR NEEDLES: ACUPUNCTURE AND DRUG ADDICTION

Jamie Whittenburg

November 13, 2008

                                                                                                                            

 

The amount of people turning to alternative care methods such as acupuncture has increased drastically, as has the money that goes into it. Ever since China opened its doors in the seventies, acupuncture has intrigued our culture. Its various uses have inspired hope for people unable to find relief in traditional Western treatments based on a biomedical model. The claims are vast but I will attempt to find the truth about one of these claims- the link between drug addiction and acupuncture.

CONCEPT BEHIND ACUPUNCTURE

First, a little background on the art, or science, of acupuncture. The theory behind acupuncture is a holistic one that dates back hundreds of years to ancient China. It aims to treat the person as whole, believing that the physical pain one suffers is often influenced by an imbalance of the qi, also pronounced “chi”.  This energy flows through your body in channels called meridians and if it is blocked or unbalanced, it can manifest physically into illness. Acupuncturists relieve the blockage by using thin needles to redirect and manipulate the energy in the body. From a western perspective, acupuncture is able to relieve pain by either triggering a drug like effect on the brain or stimulating the hypothalamus, a gland which manufactures stuff the body uses. (http://www.webmd.com/fibromyalgia/tc/acupuncture-topic-overview).  It produces an effect the Chinese call deqi, the symptoms of which is heaviness, numbness and soreness. From the eastern perspective, these are indications of healing effects (Cui, Wu and Luo 2008).

THEORIES ON HOW IT WORKS

 There are several theories about the mechanisms of acupuncture. The neurophysiology model is the belief that acupuncture points are located directly on, or close to, the nervous system. Another model is the connective tissue model with dictates that acupuncture is effective through a network of signals in the connective tissue. The third prevalent model is the growth control model which states that the growth control system, which is a basic system that serves as a genetic guide to give rise to newer physiological systems, that is a part of many systems in the body. The neurophysiology model stems from studies that show that acupuncture points closely correspond to areas of electrical conductance, such as would be needed for cells to communicate. Because of this, it is speculated that the analgesic effect is from the interaction of acupuncture with the nervous system. This model seems to be the most prevalent on the web. ( http://www.acupuncture.com/education/theory/mechanismacu.htm )New studies though, rethink the validity of a significant correlation. Focusing on five textbooks published since 1977, Stephen Birch (2003), decided to investigate this supposed correlation. After examining the literature on it, he concluded that as few as 40% of the acupuncture points originally thought to be trigger points for pain through the nervous system were correct. The other 60% percent were not found to be significant triggers of painful stimuli. The mystery of how acupuncture actually works in the body means there is no definitive model on which to work or possibly improve the study of acupuncture.

TRANSITION TO THE WEST

The west was first introduced to America in 1971 when President Nixon visited China and a columnist successfully underwent an appendectomy using acupuncture, which has become common practice in some eastern hospitals in the past 20 years. (http://www.drtowery.com/acupuncture.htm#9) Acceptance in the U.S. has been slow though. Linda Barnes (2005) explores the reasons the U.S. might be reluctant to accept such an alternative form of medicine. That we don’t exactly know how it works and different conceptions of healing have kept it from becoming a mainstream treatment for drug addicts. She states that it might aid drug addicts less in a physical way, or reproducing the effect of drugs in their head, but returns to them a sense of control that makes them receptive to treatment. Another reason acupuncture might be viewed as quackery is that Westerners do not embrace the concept of qi. Or as Judith Sutherland (2000, p.41) put it, “A Nod to Acupuncture, a Snub to Qi”. (Sutherland, 2000)It is foreign and not at all the evidence based medicine we normally would like receive when we get medical attention. Barnes (2005) has speculated that when acupuncture is viewed as a treatment separate from the concept, it opens the doors for the biomedical model to infiltrate and attempt to figure it out, which is exactly what the Western hemisphere has attempted to do with clinical studies.

EVOLUTION OF ACUPUNCTURE TREATMENT FOR DRUG ADDICTS

The first to pioneer the use of acupuncture drug therapy was Dr. Wen of Hong Kong who in 1972, accidentally discovered four key body points and two auricular points that when applied with electrical invigoration can reduce opiate withdrawal symptoms (He was treating a drug addict and after putting him under anesthesia using acupuncture, the patient declared that he felt relief from his withdrawal symptoms). The second advancement of this therapy was introduced by Dr. Smith of the aforementioned Lincoln Center, who at the time was head of NADA (National Acupuncture Detoxification Association), used just ear points in 1985 – without electrical stimulation- to treat drug addicts. It is only recently, in 2005, that Dr. Han in Beijing made another advance by reverting back to the use of electrical stimulation and points throughout the body for the treatment of heroin addicts.  (Cui, Wu and Luo 2008).

 

WHAT THEY’RE SAYING ON THE WEB

 On the web, there is a plethora of claims regarding acupuncture and its remarkable ability to cure everything from nausea to being able to anesthetize patients during surgery without chemical intervention. The sheer variety of what believers claim it can cure is staggering. It is claimed to be effective enough to treat almost anything from nausea to being able to anesthetize someone in surgery. Here’s what they’re saying on the web:

1)   In the case of drug addicts, it is thought to mitigate the effects of withdrawal, making rehabilitation an easier process for drug addicts. They are also able to treat drug addicts en masse, more so than traditional therapy, because of the ability to insert the needles into the ear (auricular therapy) and therefore be able to treat many drug addicts at once. This particular web source was a popular news article and stated articles from medical journals but acknowledged the deficiencies in these articles (http://ndsn.org/sept95/guest.html). One article they mentioned, from the British Journal The Lancet, did not demonstrate great replicability because a similar study found the effects to be no more significant than a placebo effect. They also conceded that, at the time, research on drug addiction and acupuncture was scare. They also discussed the Lincoln Clinic, a drug rehabilitation center located in New York City that first noted success with acupuncture, although the evidence offered was anecdotal.  The Lincoln Clinic supposedly influenced two judges, Chief Judge Gerald Weatherington and Judge Herbert Klein from Dade County, FL. to institute the first drug court. This article seems to genuinely want to educate people on acupuncture and recognizes its possible failures.

 

2)   Other websites are less objective (http://www.acutcmdetox.com/addcom11.htm). It is written by an acupuncturist working for an acupuncture detoxification center and he points out that he is one the first NADA (National Acupuncture Detoxification Association) in the Vancouver area. Based on his plugging for his profession, this seems considerably less reliable. He also cites the Lincoln Center as evidence, although that is one anecdotal piece of evidence and not a clinical trial. He claims that acupuncture is useful for all drugs, in any circumstance. He does not claim it to be a cure all, but comes relatively close. He indicates that it not only helps prevent cravings, but aids in a clear mind that will render the patient more amenable to counseling. On this site acupuncture for drug addicts is being hailed as revolutionary as alcoholics anonymous or pharmaceuticals. Whether this is valid is questionable and yet to be proved.

 

 

3)   Many of the articles found online are the sites of acupuncturists. They also enjoy citing the Lincoln Center as evidence although the Lincoln Center outcomes were based on observation and not in a controlled clinical setting. This one claims that drug addiction and acupuncture is supported by “excellent clinical evidence” but then again he has also put a link to a site that funds acupuncture detoxification centers at the bottom of his webpage as well as a link for his clinic hours and to testimonials. (http://acupuncturehealingarts.com/addiction.html). Like the website before, he also does not limit what kind of drugs acupuncture can treat. He says that treating drug addiction with acupuncture is similar to why one would treat overeating with acupuncture; the regulation of endorphins moderates food intake as well as produces a “runner’s high” in drug addicts. Although he says this is what “some researchers” are saying, he does not include specifics or cite any scientific journals.

THE STUDIES

1)  Wang et al. (2006) investigated the claims that auricular (needles placed at acupuncture points in the ear) therapy can help drug addicts wean off their respective drug. This particular study looked at how heroin addicts responded to acupuncture versus methadone (a heroin substitute used to eventually ease addicts off heroin but is actually quite addictive itself). They gathered 120 heroin addicts and treated one group of sixty simultaneously with methadone and acupuncture and the control group of sixty solely with methadone. To qualify for participation in the study, the addicts had to show some of these factors: have a long history of abuse, continued abuse, had to take over .5 grams a day, had to show classic signs of withdrawal, test positive for heroin in the urine, and test positive for naloxone (a drug used to cause withdrawal by irritating opiate receptors) induced addiction. The results in this study were in favor of using auricular acupuncture for treatment. They reported that not only did the treatment group exhibit signs that the acupuncture had curative effects, but that the rate of recidivism was less in those treated with acupuncture in conjunction with methadone. Of course, the study also illustrates that acupuncture alone did not account for healthier addicts, but that a combination of western and eastern medicine worked together. This study does not determine whether or not acupuncture can stand alone as a treatment for drug addicts.

         

2)  Cui et al. looked at a variety of studies in order to determine if acupuncture is truly effective in the treatment of drug addicts (2008). The first that they cite is a trial conducted at Yale University by Swartz et al. in 1999 on cocaine addicts. Eighty two patients that used methadone to delay withdrawal symptoms were selected for this study and then randomized into three separate groups. Thirteen people in group one were to receive auricular acupuncture therapy, another group of seventeen were treated with needles randomly inserted into the rim of the ear, and the other group of twenty two people were to watch relaxation videos such as videos of nature. For each group, the treatment was given five times a week for eight weeks along with a traditional treatment of methadone, counseling, and a coping skills group. Cocaine use and amount was monitored with urine tests collected three times a week. Twenty participants did not complete the study to its end. In the study’s final week, they discovered that those in the auricular acupuncture group delivered urine samples clean of cocaine significantly more often than the two control groups (54% versus 24% for the needle insertion and 9% percent for the relaxation videos). This demonstrates that in fact, acupuncture might be effective, along with methadone, in treating drug addiction. The high number that had clean urine samples from the sham acupuncture group though also indicates there might be a placebo effect occurring. Also, the participants that dropped out could have brought down the results in the true acupuncture group if they had stayed, so the percentages for the true acupuncture group could be inflated a bit.

2a) Another study Cui et al. (2008) looked at was the Cocaine Alternative Treatment     Study, succinctly known as “CATS”, conducted by Margolin et al. in 2002. It was not based in one site, but was conducted in several and on a large scale. Six treatment centers participated in this study and contributed a total of six hundred and twenty patients to the study. The treatment and control groups were the same as found in the Yale study and success was also measured with urine tests three times a week. Contrary to the Yale study, CATS found that there was no significant statistical difference among the groups in the percentage of clean urine submitted (24% for true acupuncture, 31% percent for the sham acupuncture, and 29% of the relaxation control). This ran contrary to the results of the Yale findings and it was conducted on a much larger sample. Perhaps the small number that the Yale study used was abnormal and could not therefore produce statistically significant results on a large scale. That there was still some success though for the true acupuncture and the sham acupuncture could demonstrate the possible placebo effect of believing a treatment works, or they were motivated to quit through other sources of therapy.

2b) Another Study Cui et al (2008) studied was a treatment designed for drug addicts. Because of the painful nature of withdrawal, drug addicts often have a hard time settling down to receive acupuncture and the needle can break off, if they can even get it in the precise location in the first place. Therefore, the HANS (Han’s Acupoint Nerve Stimulator, Wu et al. 1996) method was adopted. The basic premise of acupuncture was still followed, but the needles were replaced with electrodes over the points instead of needles being inserted. To study the effectiveness of this treatment, drug addicts were treated with this type of stimulation for thirty minutes over a course of ten successive days. The goal was to lower the heart rate to at or below 100 beats per minute (a symptom of heroin withdrawal can be tachycardia, which is a heart rate above 100 bpm). They received an electrocardiogram before and after treatment to measure the effectiveness. There was an immediate effect but unfortunately, it is short lived. A long term effect did not occur until the fourth day of treatment. This was significant as the control group receiving the fake HANS treatment (electrodes were placed correctly, but not stimulated) did not have a heart rate decrease until eight days after treatment. The nerve stimulator seems to prove effective and more logical for administering the therapy to drug addicts since needle breakage and incorrect insertion can occur when a patient is out of control.

3)  Attilio D’Alberto (2004), conducted a meta-analysis trying to reconcile the conflicting reports on the efficacy of acupuncture in treating drug addiction. He chose to look only at studies that he deemed demonstrated clinical strength. The criteria he set up were those trials that had participants that were primarily addicted to crack or cocaine, were randomized, single or double blinded, manual needle acupuncture only (no laser or electro-acupuncture), and a control group that used sham acupuncture points. He found six randomized trials that met his criteria and that he was able to analyze. Unfortunately, he concluded that it was not convincing either way if acupuncture worked significantly enough to be called a treatment for drug addicts, although he did determine that the five points used by NADA were the best for drug addiction based on the Chinese model. His review of the studies out there, and his conclusions about them, show that much more research needs to be done under clinical circumstances that demonstrate validity, replicability, and sensitivity.

 

 

 

SAFETY

Yes, he’s wearing a long white coat.

But where is his license?

Although acupuncture is generally considered safe, it is not free from adverse side effects. In a meta-analysis study conducted by Birch et al. (2004), they discovered there were reports of negative side effects, but mostly committed by unlicensed, badly trained practitioners. Like any health treatment, I would suggest making sure the person working on you has met professional qualifications. Unsterilized needles can transmit hepatitis among other diseases but again, a licensed, trained acupuncturist would use disposable needles or sterilize them. Major side effects aside, minor ones can and do occur. Needle pain, bleeding or bruising at the site of insertion and fainting can occur but are not long lasting effects. (Birch, K., Jonkman, Hekker, & Bos, 2004)

IS IT WORTH IT?

Given the minimal side effects, acupuncture is worth a shot if you have exhausted every other option of traditional medicine. Since the medical community is indecisive on its effectiveness, it should not be used as a primary therapy or for major health issues that have a medical solution in the hospital. It can aid those who are intolerant of anesthesia and those who have minor aches and pains, but a definitive link is yet to be drawn between drug addiction and acupuncture. Until doctors can conclusively state that acupuncture can indeed mitigate the effects of withdrawal, recognize that the positive results of acupuncture might just be a placebo effect if you choose to use it. Otherwise, keep shooting up or look for drug programs with a good counseling center and possibly a methadone supply.

 

Literature Cited

Barnes, L. L. (2005). American Acupuncture and Efficacy: Meanings and Their Points of Insertion. Medical Anthropology Quarterly , 19(3), 239-266.

Birch, S. (2003). Trigger-Point Acupuncture Point Correlations Revisited. The Journal of Alternative and Complementary Medicine , 9(1), 91-103.

Birch, S., K., H. J., Jonkman, F., Hekker, T., & Bos, A. (2004). Clinical Research on Acupuncture: Part 1. What Have Reviews of the Efficacy and Safety of Acupuncture Told Us So Far? The Journal of Alternative and Complementary Medicine , 10(3), 468-480.

Cui, C.-L., Wu, L.-Z., & Luo, F. (2008). Acupuncture for the Treatment of Drug Addiction. Neurochemical Research , 2013-2022.

D'Alberto, A. (2004). Auricular Acupuncture in the Treatment of Cocaine/Crack Abuse: A Review of the Efficacy, The Use of the National Acupuncture Detoxification Association Protocol, and the Selection of Sham Points. The Journal of Alternative and Complementary Medicine , 10(6), 985-1000.

Margolin, A. (2003). Acupuncture for Substance Abuse. Current Psychiatry Reports , 5(5),333-339.

Sutherland, J. (2000). Getting to the Point. The American Journal of Nursing , 100(9), 40-45.

Wang, Z.-T., Yi-Qin, Y., Wang, J., & Luo, J.-K. (2006). Observations on the Efficacy of Auricular-Plaster Therapy plus Medicine in Treating Heroin Addiction. Journal of Acupuncture and Tuina Science , 94-96.

 

 

 

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