Canadian Researchers Find Ear Acupuncture Effective in Treating Drug Addiction
By Editorial Staff
In the mid-1970s, Michael Smith, a medical doctor at Lincoln Hospital in New York, modified an existing system of auricular acupuncture into a simple five-point technique for the treatment of many common drug addictions as an alternative to methadone.
This selection of ear points eventually became what is now referred to as the "NADA protocol," a method of healing used at health care facilities and addiction treatment centers across North America.
In 1999, one of the largest studies on the usefulness of the NADA protocol was conducted in an area of Vancouver, British Columbia called the Downtown Eastside, a 10-city block section known for its poor socioeconomic conditions and alarmingly high concentration of drug addicts. The results of that study have been published in the current issue of the Journal of Urban Health, and provide convincing evidence that the NADA protocol is not only effective in the treatment of substance abuse, but that it is safe, easy to perform, and far less expensive to administer than other, traditional methods of detoxification.
"Acupuncture is an inexpensive treatment, and it shows real promise as part of a community-based harm reduction program to reduce substance use," enthused Dr. Patricia Janssen, an epidemiologist at the University of British Columbia and the study's lead author. "A reduction in symptoms can provide a window of opportunity for users to become engaged in more comprehensive and long-term approaches to addressing their addiction."
In the study, acupuncture was offered on a voluntary basis five days per week at two locations: a drop-in facility located in the center of the Downtown Eastside, which was open to the general public, and a residential treatment center operated by the Salvation Army. In both locations, treatment was conducted in a group setting, with a minimum of six clients receiving acupuncture at the same time.
Treatment was delivered by a licensed acupuncturist using the standard NADA protocol, with needles inserted into the Sympathetic, Shen Men, Liver, Kidney, and Lung points in both ears. A typical session lasted between 35 and 40 minutes, after which the clients removed the needles themselves and placed them in protective containers.
Before their first treatment, each client was asked to report their reasons for seeking treatment, along with which substance(s) they used most frequently. Additionally, on each Friday that they attended one of the locations, clients would complete a questionnaire that asked about drug use during the previous week and any experiences of withdrawal symptoms, with the severity of symptoms ranked using an 11-point visual analogue scale. The subjects were also invited to comment on acupuncture in a "communication book" kept at each facility.
A total of 2,755 patient visits were recorded over the course of the study, with 261 individual clients being treated for acupuncture and filling out questionnaires on Fridays, and 39 clients attending a clinic on at least four Fridays. The average interlude between treatment sessions ranged from 9.9 days to 13.4 days. Nearly 73 percent of those who attended one of the clinics cited "help with drug addiction" as the reason for seeking out care, with alcohol, heroin and crack/cocaine the substances used most often by the study population.
Of the 39 patients who attended a facility on at least four Fridays, significant reductions were seen in the severity of withdrawal symptoms in a number of categories, including drug cravings, depression, insomnia, anxiety, and suicidal thoughts. The authors noted that "the direction of change after the first treatment was consistently towards reduction in severity among all evaluated symptoms." A "significant decrease" in self-reported drug use was also observed in this client group.
In terms of safety, no needle-stick injuries were reported during the duration of the study, although four instances of patient agitation were recorded. The program was also considered cost-effective, with an overall cost of less than $36,000 for the three-month study, and an average cost per patient visit of $13.
"Our study has demonstrated the success of a voluntary inexpensive acupuncture program in engaging addicts in an acupuncture treatment, which they found to be beneficial in reducing their use of drugs," the scientists wrote in their conclusion. While there remains some question as to whether acupuncture is effective in reducing drug addiction in the long term, the researchers believed that such treatment creates "a window of opportunity ... for patients to avail themselves of longer-term alternatives to their lifestyle" by reducing one's cravings for addictive substances and the symptoms associated with withdrawal.
In an interview with the Canadian Broadcasting Corporation following the study's publication, Dr. Janssen said that she became interested in acupuncture following a series of trips to China, and wanted to see for herself if it could help to reduce drug use.
"Acupuncture is not alternative in many parts of the world. It's mainstream," Janssen said. "So, it's just a matter of having an imagination, and thinking about different possible approaches. It helped people reduce the side-effects of substance withdrawal, so it's one more tool that we have to help people withdraw from drugs."
Janssen also announced that she and a team of researchers will soon begin work on another clinical trial at the British Columbia Women's Hospital and Health Centre. The study will compare the severity of withdrawal symptoms in newborns born to drug-addicted women who receive acupuncture during pregnancy with newborns whose mothers who do not receive acupuncture while pregnant. The results of that study may help practitioners determine whether they can reduce or eliminate the need to give some newborns morphine as a way of ameliorating addiction-related pain.
Janssen PA, Demorest LC, Whynot EM. Acupuncture for substance abuse treatment in the Downtown Eastside of Vancouver. Journal of Urban Health: Bulletin of the New York Academy of Medicine 2005;82(2):285-295.
UBC research shows acupuncture reduces substance abuse in Vancouver's Downtown Eastside. University of British Columbia press release, July 5, 2005.