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A worsening opioid epidemic over the last two decades has created a public health emergency in the United States. Individuals, families, and communities have all been affected by a perfect storm of aggressive marketing, availability of drugs, and inappropriate prescribing that has led to a nation of dependence. This opioid crisis has caused distressing inclines in morbidity and mortality with drug overdose deaths now exceeding the number of fatalities caused by motor vehicles accidents [1,2]. Additional sequela includes a rise in HIV and Hepatitis C due to intravenous drug use as well as disrupted community and family dynamics [3]. The economic burden associated with increased health care, substance misuse treatment, and criminal justice is estimated to be $78.5 billion [4]. 

Providers are now seeking alternatives to opioids and must assist patients in weaning off these medications. Patients undergoing opioid detoxification may experience a multitude of symptoms including worsening pain, craving, agitation, anxiety, diarrhea, and muscle spasms [5,6]. This often complicates completion of the opioid detoxification program and leads to attrition, creating a downward spiral of other consequences related to mental health, physical health, and daily function.

Standard detoxification programs utilize a long acting opioid, most commonly buprenorphine or methadone, or patients are slowly weaned off the opioid with gradual tapers [7–9]. Additionally, rescue medications (NSAIDS, muscle relaxers, antidepressants, clonidine) and other disciplines such as pain psychology may be prescribed during the detoxification process [10]. Auricular acupuncture has demonstrated to be effective in treating many addictions such as heroin, opioids, and cocaine; but has not been studied as an outpatient symptomatic treatment in the chronic pain patient [11–13]. This therapy, following the National Acupuncture Detoxification Association (NADA) protocol, is a cost effective and feasible technique implemented in 5 points of the ear [13]. Future studies should examine the addition of acupuncture to help ease the detoxification experience and promote cessation of opioids.

References

1. Chen LH, Hedegaard H, Warner M (2014) Drug-poisoning Deaths Involving Opioid Analgesics: United States, 1999-2011. NCHS Data Brief: 1-8. [Crossref]
2. Rudd RA, Seth P, David F, Scholl L (2016) Increases in Drug and Opioid-Involved Overdose Deaths - United States, 2010-2015. MMWR Morb Mortal Wkly Rep 65: 1445-1452. [Crossref]
3. Suryaprasad AG, White JZ, Xu F, Eichler BA, Hamilton J, et al. (2014) Emerging epidemic of hepatitis C virus infections among young nonurban persons who inject drugs in the United States, 2006-2012. Clin Infect Dis 59: 1411-1419. [Crossref]
4. Florence CS, Zhou C, Luo F, Xu L (2016) The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013. Med Care 54: 901-906. [Crossref]
5. Dijkstra BA, Krabbe PF, De Jong CA, van der Staak CP (2008) Prediction of withdrawal symptoms during opioid detoxification. J Opioid Manag 4: 311-319. [Crossref]
6. Northrup TF, Stotts AL, Green C, Potter JS, Marino EN, et al. (2015) Opioid withdrawal, craving, and use during and after outpatient buprenorphine stabilization and taper: a discrete survival and growth mixture model. Addict Behav 41: 20-28.
7. Connery HS (2015) Medication-assisted treatment of opioid use disorder: review of the evidence and future directions. Harv Rev Psychiatry 23: 63-75. [Crossref]
8. Fullerton CA, Kim M, Thomas CP, Lyman DR, Montejano LB, et al. (2014) Medication-assisted treatment with methadone: assessing the evidence. Psychiatr Serv 65: 146-157. [Crossref]
9. Kourounis G, Richards BD, Kyprianou E, Symeonidou E, Malliori MM, et al. (2016) Opioid substitution therapy: Lowering the treatment thresholds. Drug Alcohol Depend 161: 1-8. [Crossref]
10. Berna C, Kulich RJ, Rathmell JP (2015) Tapering Long-term Opioid Therapy in Chronic Noncancer Pain: Evidence and Recommendations for Everyday Practice. Mayo Clin Proc 90: 828-842. [Crossref]
11. Association NAD (2015) Acupuncture Detoxification Specialist Training and Resource Manual. Fourth edn.: NADA Literature Clearinghouse. p. 203.
12. Stuyt EB, Voyles CA, Bursac S (2018) NADA Protocol for Behavioral Health. Putting Tools in the Hands of Behavioral Health Providers: The Case for Auricular Detoxification Specialists. Medicines (Basel) 5: E20 [Crossref]
13. Carter K, Olshan-Perlmutter M, Marx J, Martini JF, Cairns SB (2017) NADA Ear Acupuncture: An Adjunctive Therapy to Improve and Maintain Positive Outcomes in Substance Abuse Treatment. Behav Sci (Basel) 7: E37 [Crossref]