Deep Brain Stimulation for Severe Opioid Addiction

Repeated drug use changes the brain, which is one reason addiction is so hard to overcome. Over a period of weeks to months, use of opioids and other substances alter brain circuits as the body adapts to the effects of these chemicals.

Yet, with repeated drug use over time, the body may need more and more drug to feel the same effect. People with drug addiction often continue to use drugs to avoid the harrowing physical and psychological withdrawal symptoms from stopping drugs abruptly – creating a vicious cycle that is hard to break.

The Helping to End Addiction Long-term^® Initiative, or NIH HEAL Initiative^® recognizes that multiple strategies are needed to address all aspects of the addiction lifecycle. That means identifying risk factors, stopping overdoses, developing effective treatments, and promoting stable recovery. For each of these aspects, technology can be a powerful tool.

In a particularly innovative approach, HEAL-funded neurosurgeon Ali Rezai, M.D., of the West Virginia University Rockefeller Neuroscience Institute in Morgantown is evaluating the use of deep brain stimulation for patients with severe, treatment-resistant opioid use disorder.

Resetting the Brain

The human brain is a complex and dynamic labyrinth of interconnecting circuits. It allows us to sense the world around us as well as respond to changing conditions. In turn, the brain adapts.

“An individual is not destined to be a person with addiction, but with continued drug use they become that person over time,” Rezai explains. The brain gets “rewired” to create changes in the brain’s reward circuit deep in the brain where dopamine is released in response to rewarding stimuli like drugs.

With repeated drug use, however, dopamine production drops off, and craving intensifies. More and more drug is needed to produce a high. The reward circuit sends signals to another part of the brain, the prefrontal cortex, which helps control behavior and is important for decision making and working toward goals.

Overstimulation of the reward center and understimulation of the behavior control center create a difficult combination: the desire and physiological need to use more drugs and less impulse control to resist. In this scenario, it is very difficult for people who try to quit drugs.

Rezai is leading a HEAL research study to help change brain circuits whose activity underlies drug addiction, using focused electrical energy from an implanted device. Called deep brain stimulation, the procedure is sort of like a pacemaker for the brain that can restore a healthy electrical activity and rhythm. Over the past 30 years, neurosurgeons like Rezai have inserted more than 200,000 deep brain stimulation implants into patients with a range of neurologic disorders.  

Stimulating Hope

Deep brain stimulation delivers a mild electrical current to a specific brain region to alter its activity, tuning it up or down. The technique has been used successfully to treat Parkinson’s disease, where it acts like and on-off switch for tremors characteristic of this debilitating movement disorder. Deep brain stimulation is also used to treat epilepsy and obsessive-compulsive disorder, and researchers are testing deep brain stimulation for several other conditions including chronic pain, depression, and Alzheimer’s disease.

Rezai’s HEAL research is now testing deep brain stimulation as part of a strategy for opioid use disorder that has not responded to other treatments. Rigorously designed experiments are critical for determining whether this technology, in combination with other treatments like medication and counseling, can reset the brain and lead to reduced drug use. Although some studies have been done in China and Europe, Rezai’s is the first to be designed, controlled, and regulated by the U.S. Food and Drug Administration to determine how well this approach works.

Participants in Rezai’s deep brain stimulation study have chronic, severe opioid use disorder. These individuals (four, so far) have experienced multiple overdoses and typically have not responded to all of the treatments they have tried: inpatient, outpatient, or sober housing approaches. Participating in this research study represents a big leap of hope for recovery.

Determining if the approach is safe is the current goal. In the coming months, 20 more patients will receive an implant toward bringing their brain back into balance. If deep brain stimulation proves to be effective for stabilizing their brain rhythms as planned, the approach might offer a life-changing opportunity for people who have exhausted other options.