A new electronic device has been approved for the treatment of withdrawal symptoms in opioid-dependent people.The device is called NSS-2 Bridge approved by the US Food and Drug Administration.The approval was based on a study that involved 73 patients who experienced physical symptoms of withdrawal from drug use.
The NSS-2 Bridge is a portable device that delivers a small electrical current to the occipital and cranial nerves V, VII, IX, and X.It is placed behind the ear of the patient.The electrical current is produced by a battery-powered chip.The device can be used with a prescription.
"Given the scope of the epidemic of opioid addiction, we need to find innovative new ways to help those currently addicted live lives of sobriety with the assistance of medically assisted treatment.There are three approved drugs for helping treat opioid addiction.While we continue to pursue better medicines for the treatment of opioid use disorder, we also need to look to devices that can assist in this therapy," said Dr.Scott Gottlieb, the FDA Commissioner.
In the study, the 73 patients had an average clinical opiate withdrawal scale or COWS score of 20.1 before the use of NSS-2 Bridge, if the COWS score is higher, the symptoms are worse.Clinical symptoms of withdrawal from narcotics include anxiety, sweating, tremors, gastrointestinal problems, and pain in the bone and joints.After 30 minutes of use, the patients' COWS score has been reduced to 31 percent.About 88 percent or 64 out of 73 patients switched to medication-assisted therapy after five days of using the portable device.However, the device is not applicable to patients with hemophilia, cardiac pacemakers, and psoriasis.
Biological Mechanism of Drug Dependence
The repeated use of a substance, such as alcohol or narcotics, can develop dependence after the brain's neurons adapt to the repeated exposure.Drug dependence is a state in which the person can only function normally with the presence of a drug.When the drug is removed, physical disturbances occur which are called withdrawal.Symptoms associated with withdrawal include increased sensitivity to pain, irritability, insomnia or restlessness, emotional instability like anxiety and depression, sweating and hot flashes, appetite loss, and flu-like symptoms such as body aches, headaches, weakness.
The severity of the withdrawal symptoms depends on what chemical caused the dependence and how long was it used.Caffeine may cause mild withdrawal symptoms while alcohol abuse can lead to severe symptoms.Sometimes, severe symptoms can force the person to retake the abusive substance to relieve the pain of withdrawal.
The development of substance dependence involves specific areas of the brain such as the thalamus and the brainstem in people addicted to narcotics.Since these are the parts of the nervous system dependent on drugs, withdrawal symptoms are usually generated from opiate receptors located in these areas when deprived of narcotics.
Addiction and dependence on narcotics like heroin are handled by different areas of the brain.Some people dependent on drugs may not be addicted to it, but a person addicted to drugs is likely dependent on the substance.The effects of drug removal from addicted and drug-dependent people are similar.For example, a patient with a terminal disease like cancer needs strong pain-killers.Narcotics, such as heroin and hydrocodone, may be prescribed to that patient to treat chronic pain but, will suffer withdrawal symptoms if the drugs are terminated.However, the patient is not a compulsive user of the medication thus, not necessarily addicted to it.
Medication Assisted Therapy
There are three approved medications for the treatment of opioid-dependence – methadone, buprenorphine, and naltrexone.
1.Methadone is a synthetic opioid agonist -- a drug that eliminates withdrawal symptoms and relieves the cravings.The chemical acts directly to the opiate receptors in the brain, the same receptors for other morphine.It slowly activates and occupies these receptors to provide the comfort needed but not the feeling of euphoria found in high dosage.
2.Buprenorphine is a partial opioid agonist.The drug binds to the same receptors but is not as strong as full agonists like methadone.Similar to methadone, buprenorphine reduces withdrawal symptoms and cravings, without euphoria.
3.Naltrexone is an opioid antagonist.It works by blocking the activation of opioid receptors.It treats drug addiction by preventing the pleasurable and rewarding effects of any narcotic instead of managing the cravings and symptoms of withdrawal.The medication's use for drug-dependence treatment has been limited due to poor commitment and low tolerability of the patients.
Not every treatment option can work for every person because each person has a different addiction level and personal reason for drug abuse.Each person is given to try out every method possible that works for them.In order to achieve freedom from drug-dependence, a person must commit to abstinence.Medication-assisted therapies may be combined with other methods to help the patient to cope, such as a recommended physical activity like yoga or sports, joining a support group, and psychotherapy.