The opioid crisis continues to cause harm to millions of individuals in the U.S.
Analysis from the Centers for Disease Control (CDC) shows the opioid crisis began around 1999, as prescriptions for opioid pain relievers increased and drove up rates of both opioid use disorder and opioid overdose nationwide.
If the crisis began in 1999, that means two years ago, in 2019, the crisis entered its third decade. And as of 2021, rates of fatal overdose for opioids – and all drugs of misuse – continue to increase.
We know the most effective, evidence-based treatment for opioid use disorder (OUD) is medication-assisted treatment (MAT), which is an approach that includes medication – buprenorphine, naltrexone, and methadone – in combination with individual/family/group therapy, community support, lifestyle changes, and in some cases, complementary supports such as exercise, meditation, mindfulness practices, and therapeutic techniques such as massage therapy and acupuncture.
This article examines new research on the effectiveness of a substance use disorder-specific acupuncture protocol for people with OUD currently participating in a medication-assisted treatment program. The study we discuss, published in China in August 2021, explored a simple research question:
Can adjunctive acupuncture therapy reduce the amount of medication needed for people participating in an MAT program?
Before we share the results of that study, we’ll offer a brief overview of the use of acupuncture in addiction treatment and mainstream medical practice the U.S.
Note: in the context of this article, and in treatment for OUD in general, the words adjunctive and complementary mean in addition to. In other words, acupuncture and other adjunctive or complementary therapies never replace primary, evidence-based modalities, but rather support them and improve outcomes as part of an integrated, holistic approach to treatment.
Now, back to our topic.
Does Acupuncture Really Work?
For most people in the West – meaning Western Europe and the U.S. – that’s the million-dollar question. We know a little about acupuncture, know it’s been used in China for thousands of years, and know it became relatively common here in the second half of the 20th century.
We know people swear by its effectiveness – but is there a solid clinical evidence base for the use of acupuncture?
Let’s take a look.
Acupuncture in the West: An Overview
- Treatment providers at Lincoln Detox Center in New York City developed a protocol to mitigate the symptoms of withdrawal for heroin users
- The Lincoln Protocol became the National Acupuncture Detoxification Association (NADA) Protocol, was approved for use in addiction treatment, and is now in use in hospitals across the U.K. and U.S.
- The Food and Drug Administration (FDA) removes barriers to the use of acupuncture for medical treatment
- The National Institutes of Health (NIH) approve acupuncture as an acceptable complementary therapeutic technique for use alongside Western medicine
- Evidence indicates acupuncture as an effective complementary treatment for:
- Chronic pain
- Parkinson’s disease
- Evidence indicates acupuncture as an effective complementary treatment for:
That’s the current state of acupuncture as an official medical treatment in the U.S.
While it’s neither accepted nor recommended as a primary therapeutic technique for medical conditions or mental health disorders, its effectiveness as a complementary, supportive approach – especially during detoxification from substance of misuse – is gaining acceptance by the substance use disorder treatment community.
Now let’s look at the research from China we mention in the introduction to this article, and learn whether acupuncture may also be a practical, effective, complementary treatment for people with OUD on MAT.
The Effect of Acupuncture on MAT Dosage
The study, called “Clinical and Economic Evaluation of Acupuncture for Opioid-Dependent Patients Receiving Methadone Maintenance Treatment: The Integrative Clinical Trial and Evidence-Based Data,” examined the effect of adjunctive – a.k.a. complementary – acupuncture on medication dosage for 135 patients in a methadone based MAT program in the Substance Dependence Department of Guangzhou Huaiai Hospital in Guangzhou, China.
To justify the research, study authors cite several data sources:
- A random control trial in China that showed acupuncture decreased methadone dosage in patient on MAT for OUD
- Another random control trial in China that showed acupuncture reduced opioid cravings for people on MAT for OUD
- A retrospective analysis on U.S. Air Force personnel showed reductions in opioid prescriptions for servicemembers who received acupuncture treatment
- A meta-analysis that identified four trials in which adjunctive acupuncture treatment improved treatment retention and decreased methadone maintenance dosage for people on MAT for OUD
In this study, researchers divided participants into two groups: one group engaged in methadone-based MAT as usual, and the other received acupuncture in addition to MAT. Researcher collected data on methadone dosage, drug cravings, sleep quality, and quality of life at baseline, four weeks, and six weeks after the initiation of the experimental protocol.
Here’s what they found.
The Effect of Acupuncture on Methadone Dosage, Sleep Quality, and Quality of Life
Compared to the control group, patients on MAT for OUD showed:
- Decreased daily methadone dosage:
- By week six, daily dosage for the acupuncture group decreased by 17.68 mg
- By week six, daily dosage for the non-acupuncture group decreased by 1.07 mg
- Decreased drug cravings:
- By week six, drug cravings for the acupuncture group improved significantly
- By week six, drug cravings for the non-acupuncture group did not improve
- Improved sleep quality:
- By week six, sleep quality for the acupuncture group improved significantly
- By week six, sleep quality for non-acupuncture group did not improve
- Quality of life:
- Quality of life did not differ at statistically significant levels for the acupuncture group compared to the non-acupuncture group
Those results add to the growing body of evidence confirming the effectiveness of acupuncture as a complementary therapy for people with OUD on MAT. People in recovery from OUD often cite the intensity of cravings and sleep problems as primary drivers or relapse. This data suggests that acupuncture can improve cravings and sleep quality while simultaneously reducing daily methadone dosage. The combination of those findings tell us that acupuncture fits well with other complementary therapies: like yoga, exercise, and meditation, it can improve outcomes across several key recovery metrics.
Complementary and Adjunctive Supports in Practical Application
The evidence base for the use of complementary supports in treatment for substance use disorder grows more robust every day. The study we discuss here addresses acupuncture and medication-assisted treatment in combination for opioid use disorder, which is important because of its timeliness. As the opioid crisis continues to have a negative impact on individuals, families, and communities across the U.S., we need to employ every tool at our disposal to mitigate that impact, and its associated pain and suffering.
This study suggests that acupuncture is one tool treatment professionals can use – in the context of an integrated, comprehensive, holistic approach to treatment – to help improve outcomes for people in recovery from opioid use disorder.
In our effort to mitigate the harm caused by the opioid crisis, that’s good news, and an indication that innovation and tradition can work side-by-side to create new, effective therapeutic approaches that promote long-term, sustainable recovery.