A surgeon has implanted electrodes in the brain of a patient suffering from severe opioid use disorder, hoping to cure the man's intractable craving for drugs in the first such procedure performed in the United States.
The device, known as a deep brain stimulator, is designed to alter the function of circuits in the man's brain. It has been used with varying degrees of success in the treatment of Parkinson's disease, dystonia, epilepsy, obsessive-compulsive disorder and even depression.
It is seen as a last resort therapy after the failure of standard care, such as medication
The deep brain stimulator, which functions much like a heart pacemaker, was implanted by Ali Rezai, executive chairman of the West Virginia University Rockefeller Neuroscience Institute.
His patient, 33-year-old. old hotel worker Gerod Buckhalter said he was unable to stay sober for more than four months because of the age of 1
Buckhalter is the first of four people in a a pilot program that aims to demonstrate that the technique is safe so that a full-scale clinical trial can be conducted. It aims at a small percentage of opioid abusers with the most treatment-resistant cravings for opioids, who may face a lifetime of overdoses, relapses, inability to hold a job and other addiction causes.
The seven-hour surgery was performed Friday, and the school announced it Tuesday.
"I'm not advocating for deep brain stimulation as a first line or a second line [treatment]," Rezai said.
] "It's for people who have failed everything because it is brain surgery."
Rezai's surgical team opened a hole in Buckhalter's skull about the size of a nickel, then inserted four wires into his nucleus accumbens, and part of the brain's
Except when the hole was cut in his skull, Buckhalter was awake and providing feedback throughout the procedure, Rezai said.
By sending a pulsed current through the electrodes, doctors believe they can regulate an imbalance in Buckhalter's reward circuitry. The intervention may also prevent his condition from worsening, Rezai said. Under normal circumstances, his cravings might continue to become stronger, he said.
The wires run from the stimulator, about the size of a pocket watch, and the battery, which were implanted behind Buckhalter's collar bone, to his brain.  Using wireless technology, doctors will adjust the current going through the electrodes to provide more or less stimulation to the nucleus accumbens, depending on Buckhalter's needs.
Rezai acknowledges that doctors and researchers do not yet fully understand how this works.
"The exact mechanisms are not known," he said. By modulating the reward circuit, which relies on a chemical messenger called dopamine, "you're getting better control, you're not craving dopamine as much," he said.
The same type of surgery for other diseases has relieved debilitating symptoms, including motor problems experienced by Parkinson's patients.
The same surgery for people with opioid use disorder has been performed in China and Holland, said Helen S. Mayberg, director of the Center for Advanced Circuit Therapeutics at Mt. . Sinai Medical Center's Icahn School of Medicine, and has also tried as a cure for alcoholism.
Other countries have employed different approaches for people with the most severe addictions as the opioid crisis continues. In Canada, for example, a few small programs offer hardcore heroin addicts a pharmaceutical-grade version of the drug so they can function.
Rezai's effort is believed to be the first attempt to use deep brain stimulation on opioid use disorder in the United States. It is partly funded by the National Institute on Drug Abuse (NIDA) and requires approval from, among other agencies, the US Food and Drug Administration.
Nora Volkow, NIDA's director, said she spoke with a handful of patients who underwent the procedure in China and concluded that surgery had potential. They told her that after the operation, they were no longer consumed by the need to acquire drugs and were able to pay attention to other things.
"They reported more of an ability to engage, to feel interest in other things," she said.
Mayberg, who was not involved in the trial, said that the logic of effort is sound and that the circuitry of this part of the brain is well -mapped compared to other regions. The key question is whether the researchers have found the precise spot for the insertion of the electrodes.
"The precision of where you put it is key," she said. "Different nodes are good for different kinds of problems because circuits are abnormal in different ways."
Linda J. Porrino, a professor of physiology and pharmacology at the Wake Forest School of Medicine, said animal studies and anecdotal records among people who have
But there are also reports of side effects from stimulation, including cognitive disabilities and forgetfulness, said Porrino, who's who had deep brain stimulation for other ailments indicating the procedure could be helpful in curbing cravings for opioids, alcohol, nicotine and cocaine. was not part of the west Virginia effort. This is why a controlled clinical trial is critical to advancing the use of this technology, she said.
In a telephone interview from a hospital in Buckhalter, who lives in Dilliner, Pa., He was given Percocet at age 15 after surgery on his shoulder for a football injury. Within days, he was addicted to the drug, he said.
"I felt instantly addicted," he said. "I instantly fell in love with the feeling that gave me – within the first couple of days. I instantly knew this medicine was something I was going to have."
Buckhalter said he was soon turned to heroin, lost to a football scholarship and has a lathe with addiction ever since. Without drugs, he said, he was unable to feel joy or pleasure.
But soon, the high he had experienced disappeared, and he needed opioids just to put off the pain of withdrawal. In later years, he became more dependent on benzodiazepines, such as Xanax, than on opioids.
He had overdosed twice and tried a range of inpatient and outpatient treatments without success.
"I've had every type of treatment you could think of, "Buckhalter said. "Numerous stays in long-term treatment, numerous detoxes. You name it, I've had it."
Buckhalter said he wasn't trying to consider what he would do if deep brain stimulation didn't work for him.  "If it doesn't work, then it doesn't work," he said. "I was in the same position a month ago, before I came in."
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