‘The search for an acceptable electrophysiological ‘addiction’ treatment has come far’

The underlying principle of therapeutic electrostimulation – if only dimly understood by its early pioneers such as Luigi Galvani and his nephew Giovanni Aldini, who sought to treat contemporary mental illnesses with galvanic stimulation (non-invasive electrical stimulation of the nerves via electrodes applied directly on the skin) – is that an electrically functioning body should respond equally well to electrical remedies as to chemical interventions.

This hypothesis holds firm two centuries later, even if the journey towards serious scientific and clinical consideration has been fraught, and frequently, controversial.

“The underlying principle of therapeutic electrostimulation is that an electrically functioning body should respond equally well to electrical remedies as to chemicals”

Not least when psychiatrist Peter Roper of the Allan Memorial Institute of Psychiatry, McGill University, Montreal, claimed electro-convulsive therapy (ECT) to be “one of the most effective techniques of changing psychotic behaviour”, after proposing “intensive ECT should be considered in drug addicts with an otherwise poor prognosis” (Roper, 1966).

According to Roper, the “de-patterning... disorientation…re-patterning” sleep-and-shock technique, developed by psychiatrist Professor Ewan Cameron of McGill University in the 1950s, made ECT “an appropriate clinical intervention” for preventing relapse in what he called the “irrational” behaviour of “drug addiction” (now designated as substance use disorder).

Already notorious, ECT (‘electro-shock’ in America) became even more so when the unethical use of sleep-and-shock in medical brain-washing experiments and its funding by the CIA, was finally revealed. Roper and Cameron’s ‘re-patterning’ advocacy was discredited and ECT, though eventually approved in much modified form for severe depression, never became an accepted ‘addiction’ treatment.

Dr Robert Heath, head of the Department of Psychiatry and Neurology at Tulane University, Louisiana, and an early pioneer of what would come to be known (and regulatorily approved) as deep brain stimulation (DBS), generated similar public revulsion.

His research in the 1950s and ‘60s into the use of implanted electrical stimulation of the brain’s pleasure areas to treat a range of ‘treatment-resistant’ psychiatric conditions – primarily schizophrenia, but also homosexuality, and ‘drug addiction’ (which he described as “a neurological defect”) – also failed to survive public exposure.

Even in the social context of attitudes of the era, which were disturbingly casual, Heath’s boundary-pushing was deemed unethical by many – although also “courageous” and “determined” by some (O’Neil et al, 2017).

If such extreme applications left enduring scepticism, more cautious and considered experimental use of electrostimulation, as well as increased regulatory oversight, began to establish sound scientific, clinical and ethical foundations.

Out of these foundations, technological advances and clinical innovation pushed forward a range of diagnostic and treatment possibilities, while scientific research began to elucidate the mechanisms involved in targeted electrostimulation, including those impacting on underlying intrinsic pleasure, pain-control, and dependency processes.

An early use of non-shock electrostimulation as an intervention for ‘addiction’ came in 1973, when Hong Kong neurosurgeon Dr Hsiang Lai Wen suggested his investigation of electro-acupuncture analgesia showed the approach might also have the potential to reduce opiate withdrawal suffering and craving in surgical patients with an opiate dependency.

Wen reported that electro-acupuncture stimulation would, after 15-20 minutes, consistently result in drying of the eyes and mouth, decrease in shivering, and reduction in both reported and observable anxiety (Wen and Cheung, 1973).

Similarly, use of Professor Aimé Limoge’s electro-anaesthesia device, which had reduced the amount of opiates required in surgery in France, was subsequently investigated for its potential for reducing heroin withdrawals.

By 1987, having treated over 500 heroin users, the Bordeaux doctors reported favourably: “After about 50 hours stimulation a Naloxone test produced little or no reaction in the patients” (Auriacombe et al, 1990).

In the US, an early blinded clinical trial of cerebral electrotherapy (CET) to support methadone-assisted withdrawal from heroin, likewise reported positively: “Nine of the patients receiving active CET were drug free by the end of 8 to 10 days, and all experienced a marked reduction of their symptoms; the control group did not show significant changes’ (Gomez and Mikhail, 1979).

In 2018, America’s Food and Drug Administration stated that medical devices have “a unique and important role” in tackling the nation’s opioid crisis.

By 2022, three randomised clinical trials of electrostimulators for opioid use disorder were listed in ClinicalTrial.gov, including a study with which these authors are involved, since deemed by the FDA to be a “pivotal” investigation of neuromodulation for opioid use disorder.

These scientifically rigorous investigations are intended to definitively, answer the vexed question of whether this distinctive approach for opioid use disorder is safe and efficacious.

Lorne Patterson is a British psychiatric nurse living in Ireland. He provided remote support for a US clinical trial of a neuromodulator device for opioid use disorder. Myrrh Winston is an emergency department nurse in the US and clinical trial manager for the same study, detailed in: Greenwald, M K et al (2022). A randomized, sham-controlled, quintuple-blinded trial to evaluate the NET device as an alternative to medication for promoting opioid abstinence. Contemporary Clinical Trials Communications; 30, 101018.

Disclosure: Both authors have ongoing involvement with the private health care company whose device underwent blinded investigation in the above paper.

References

Auriacombe M et al (1990) Transcutaneous electrical stimulation with Limoge current potentiates morphine analgesia and attenuates opiate abstinence syndrome. Biological Psychiatry; 28:8, 650-656.

Gomez E, Mikhail AR (1979) Treatment of methadone withdrawal with cerebral electrotherapy (electrosleep). The British Journal of Psychiatry; 134:1, 111-113.

O'Neal CM et al (2017) Dr. Robert G. Heath: a controversial figure in the history of deep brain stimulation. Neurosurgical Focus; 43:3, E12.

Roper P (1966) Drug addiction, psychotic illness and brain self-stimulation: effective treatment and explanatory hypothesis. Canadian Medical Association Journal; 95:21, 1080.

Wen HL, Cheung SYC (1973) Treatment of drug addiction by acupuncture and electrical stimulation. Asian Journal of Medicine; 9, 138-141.