For people who are addicted to heroin, fentanyl, or prescription opioids, the withdrawal symptoms that come with starting recovery can be a big roadblock.
But a nerve stimulation device recently approved by the U.S. Food and Drug Administration (FDA) may help clear a road toward recovery.
This comes as the opioid epidemic across the country shows no sign of slowing.
In 2015, more than 33,000 people in the United States died due to opioid overdoses, according to the Centers for Disease Control and Prevention (CDC).
Nearly half of these deaths involved prescription opioids such as hydromorphone and oxycodone.
Withdrawal symptoms — such as upset stomach, agitation, insomnia, and joint pain — occur when a person with an opioid addiction abruptly stops using these drugs.
As with any drug addiction, fear of withdrawal symptoms can make it difficult for people to quit using opioids.
“Because of the negative mental, emotional, and physical symptoms related to withdrawal, people are often driven to seek out and use drugs again,” Jonathan Harris, PhD, corporate director of neurocognitive services at Caron Treatment Centers, told Healthline.
Current opioid withdrawal treatments
Although nerve stimulation devices have previously been approved to treat depression and epilepsy, this is the first device approved for withdrawal symptoms.
Currently, opioid withdrawal is most often treated using medications, such as buprenorphine and methadone.
“This approach protects patients from experiencing a sudden crash with overwhelming withdrawal symptoms,” said Harris, “and helps to reduce the likelihood that patients would immediately return to drug use.”
Methadone is a full opioid agonist. This means it binds completely to the same “mu” opioid receptors in the brain as heroin and other opioids. Buprenorphine is a partial agonist.
Targeting these opioid receptors in the brain can provide relief from withdrawal symptoms. As long as the medication dose is right.
“By giving low-dose methadone and tapering it over days, you effectively reduce or completely ameliorate withdrawal symptoms, which arise because of an abrupt cessation of a mu receptor agonist like heroin,” Dr. Joseph Garbely, vice president of medical services and medical director at Caron Treatment Centers, told Healthline.
During supervised withdrawal, buprenorphine is tapered in the same way, with similar results.
Controlling withdrawal symptoms makes it easier for people to stick with an addiction treatment program.
Garbely said that by using buprenorphine or methadone, less than 3 percent of Caron’s patients leave supervised withdrawal early.
Withdrawal symptoms can also be treated directly, such as by using medications that relieve nausea, muscle aches, or anxiety.
But this may not work as a stand-alone treatment.
“This strategy waits for someone to have withdrawal symptoms before giving symptom-specific medication,” said Garbely. “This approach leads to decreased patient retention during withdrawal management.”
At Caron, they use these medications alongside buprenorphine to treat symptoms as they occur.
This can reduce withdrawal symptoms enough for people to stick with the treatment program.
Nerve stimulation for opioid withdrawal
Still, opioid withdrawal symptoms are strong enough — even during supervised withdrawal — that some people are deterred from even trying.
By reducing withdrawal symptoms, the NSS-2 Bridge device may help overcome that barrier.
The device, which is available only by prescription, is worn behind the ear. It uses electrical pulses to stimulate certain cranial nerves.
This can provide relief from symptoms of opioid withdrawal.
The FDA reports that in a small clinical study of 73 people undergoing physical opioid withdrawal, the device reduced withdrawal symptoms by at least 31 percent within 30 minutes of use.
About 88 percent of those people were able to move to medication-assisted therapy after five days of using the device.
More research, including randomized controlled trials, is needed to show that the device helps people successfully stop using opioids.
Harris said this might include studies that randomly assign people to receive either cranial nerve stimulation or placebo treatment with no stimulation.
“This type of controlled study design allows researchers to determine whether the effect they see is, in fact, due to the treatment they’re studying or some other unaccounted for factor,” said Harris.
Harris added that additional studies would help scientists understand why stimulating the cranial nerves reduces withdrawal symptoms.
But like medications that treat withdrawal symptoms directly, the device may work best alongside standard treatments for withdrawal.
“Given the magnitude of the current opioid problem we are facing and the aversive symptoms individuals experience when going through withdrawal,” Harris said, “this device might be a useful tool to assist patients through the withdrawal process, lessening negative symptoms, and improving treatment retention.”