a-z indexroundtableArticles & Editorialsmarketplacemeet the publisherscontactsearch

Acupuncture and Opiate Use: An overview of possibilities for withdrawal and pain modification for the workers' compensation patient
By Frances Kalfus, O.M.D., L.Ac.

There is abundant research regarding the effectiveness of particular acupuncture protocols in assisting the addicted person to withdraw from opiates. Acupuncture is an established modality used for treating workers’ compensation patients in the last two to three decades in California. Acupuncture is a modality identified in the medical treatment utilization schedule (MTUS) Chapter 4.5. Division of Workers’ Compensation, section 9792.24.1. Based on reams of studies and analyses, it is essential to recognize the formidable effects that acupuncture can provide to treat opioid addiction.

There is abundant research regarding the effectiveness of particular acupuncture protocols in assisting the addicted person to withdraw from opiates. One protocol, the most commonly used in over 250 hospital settings in the United States and United Kingdom, as well as by nearly 1000 licensed drug treatment programs in the U.S., was developed in the mid 1970s by Michael O. Smith, M.D., Medical Director of Substance Abuse Division at Lincoln Hospital in New York City. Historical perspective brings us to Hong Kong, 1972, when neurosurgeon Dr. H. L. Wen used acupuncture and electrostimulation at four body points and 2 ear points for surgical analgesia on his opioid addicted patient who later expressed amelioration of withdrawal symptoms. Dr. Smith read about this response in a medical journal, began working with addicted clients using acupuncture, developed a well established protocol and by 1985 founded the National Acupuncture Detoxification Association (NADA) to educate and train acupuncturists in his methodology, as well as help expand the use of acupuncture for treatment of drug addicted persons.

In 1996, the World Health Organization listed 64 medical problems considered suitable for acupuncture treatment including treatment of drug abuse for the opiate addicted. It was concluded that this form of treatment was inexpensive, had no side effects, and could be used for relapse.

Acupuncture is a modality identified in the medical treatment utilization schedule (MTUS) Chapter 4.5. Division of Workers’ Compensation, section 9792.24.1: (1) “Acupuncture” is used as an option when pain medication is reduced or not tolerated, it may be used as an adjunct to physical rehabilitation and/or surgical intervention to hasten functional recovery. It is the insertion and removal of filiform needles to stimulate acupoints (acupuncture points). Needles may be inserted, manipulated, and retained for a period of time. Acupuncture can be used to reduce pain, reduce inflammation, increase blood flow, increase range of motion, decrease the side effect of medication-induced nausea, promote relaxation in an anxious patient, and reduce muscle spasm. (2) “Acupuncture with electrical stimulation” is the use of electrical current (micro-amperage or milli-amperage) on the needles at the acupuncture site. It is used to increase effectiveness of the needles by continuous stimulation of the acupoint. Physiological effects (depending on location and settings) can include endorphin release for pain relief, reduction of inflammation, increased blood circulation, analgesia through interruption of pain stimulus, and muscle relaxation. It is indicated to treat chronic pain conditions, radiating pain along a nerve pathway, muscle spasm, inflammation, scar tissue pain, and pain located in multiple sites. (3) “Chronic pain for purposes of acupuncture” means chronic pain as defined in section 9792.20(c).

Acupuncture is an established modality used for treating workers’ compensation patients in the last two to three decades in California. It is prescribed when chronic pain conditions caused by injuries do not adequately reduce with use of pain medications, physical and occupational therapies, etc. Acupuncture treatment has increasingly been recognized as well by the western medical community for its effectiveness in reducing initial/acute pain syndromes before they become chronic and cause excessive use of pain medications.

Presently, workers’ compensation patients are experiencing an ever growing population of pain medication addiction. By definition, opioids are addictive. In order to maintain function, their addictive nature easily ensues. This is where the narrow overlap occurs between drug addicts and injured workers’ overuse of pain medications, and where research inquiries regarding effective treatment of acupuncture for treatment of drug-addicted persons can be applied to workers compensation patients.

In 2008 Yang, et.al. in “Acupuncture Treatment for Opiate Addiction” reviewed multiple studies exploring possible mechanisms underlying acupuncture's effectiveness in treating drug addicts. I include his references below.

There is a growing urgency to recognize the phenomenon of addiction to pain meds in the workers’ compensation patient population. In order to allay, reduce, and eventually eliminate this growing problem, several steps need to occur: 1. Recognition on the part of the prescribing practitioner; 2. Recognition by the patient; 3. Treatment and appropriate support to remove addiction.

Based on reams of studies and analyses, it is essential to recognize the formidable effects that acupuncture can provide to treat opioid addiction.

1. Wu JN. A short history of acupuncture. Journal of Alternative and Complementary Medicine.1996;2(1):19–21.
2. Kim YS, Jun H, Chae Y, et al. The practice of Korean medicine: an overview of clinical trials in acupuncture. Evidence-Based Complementary and Alternative Medicine. 2005;2(3):325–352.[PMC free article] [PubMed]
3. Kobayashi A, Uefuji M, Yasumo W. History and progress of Japanese acupuncture. Evidence-Based Complementary and Alternative Medicine. 2010;7(3):359–365. [PMC free article] [PubMed]
4. Yang CH, Lee BH, Sohn SH. A possible mechanism underlying the effectiveness of acupuncture in the treatment of drug addiction. Evidence-Based Complementary and Alternative Medicine.2008;5(3):257–266. [PMC free article] [PubMed]
5. Niu C, Hao H, Lu J, Li L, Han Z, Tu Y. A novel Uni-acupoint electroacupuncture stimulation method for pain relief. Evidence-Based Complementary and Alternative Medicine. 2011;2011 Article ID 209879.
6. Xu YH, Wang QY, Yu ZB, He YW. Clinical observation on acupuncture for treatment of abdominal postoperative pain. Chinese Acupuncture and Moxibustion. 2010;30(11):904–906. [PubMed]
7. Hsieh CL, Yu JS, Shen KH, Chen WC, Her JS. Effects of electroacupuncture on benign prostate hyperplasia patients with lower urinary tract symptoms: a single-blinded, randomized controlled trial.Evidence-Based Complementary and Alternative Medicine. 2011;2011 Article ID 303198.
8. Zheng GQ, Zhao ZM, Wang Y, et al. Meta-analysis of scalp acupuncture for acute hypertensive intracerebral hemorrhage. Journal of Alternative and Complementary Medicine. 2011;17(4):293–299.
9. Gori L, Firenzuoli F. Ear acupuncture in European traditional medicine. Evidence-Based Complementary and Alternative Medicine. 2007;4(1):13–16. [PMC free article] [PubMed]
10. Kong J, Fufa DT, Gerber AJ, et al. Psychophysical outcomes from a randomized pilot study of manual, electro, and sham acupuncture treatment on experimentally induced thermal pain. Journal of Pain.2005;6(1):55–64. [PubMed]
11. Brumbaugh AG. Acupuncture: new perspectives in chemical dependency treatment. Journal of Substance Abuse Treatment. 1993;10(1):35–43. [PubMed]
12. Cui M. Advances in studies on acupuncture abstinence. Journal of Traditional Chinese Medicine.1995;15(4):301–307. [PubMed]
13. Clement-Jones V, McLoughlin L, Lowry PJ. Acupuncture in heroin addicts: changes in met-enkephalin and β-endorphin in blood and cerebrospinal fluid. The Lancet. 1979;2(8139):380–382.
14. Cui CL, Wu LZ, Luo F. Acupuncture for the treatment of drug addiction. Neurochemical Research.2008;33(10):2013–2022. [PubMed]
15. McLellan AT, Grossman DS, Blaine JD, Haverkos HW. Acupuncture treatment for drug abuse: a technical review. Journal of Substance Abuse Treatment. 1993;10(6):569–576. [PubMed]
16. D’Alberto A. Auricular acupuncture in the treatment of cocaine/crack abuse: a review of the efficacy, the use of the national acupuncture detoxification association protocol, and the selection of sham points.Journal of Alternative and Complementary Medicine. 2004;10(6):985–1000.
17. Margolin A. Acupuncture for substance abuse. Current Psychiatry Reports. 2003;5(5):333–339.[PubMed]
18. Weiss F, Paulus MP, Lorang MT, Koob GF. Increases in extracellular dopamine in the nucleus accumbens by cocaine are inversely related to basal levels: effects of acute and repeated administration.Journal of Neuroscience. 1992;12(11):4372–4380. [PubMed]
19. Peoples LL, Uzwiak AJ, Guyette FX, West MO. Tonic inhibition of single nucleus accumbens neurons in the rat: a predominant but not exclusive firing pattern induced by cocaine self- administration sessions. Neuroscience. 1998;86(1):13–22. [PubMed]
20. Rossetti ZL, Isola D, De Vry J, Fadda F. Effects of nimodipine on extracellular dopamine levels in the rat nucleus accumbens in ethanol withdrawal. Neuropharmacology. 1999;38(9):1361–1369. [PubMed]
21. Diana M, Pistis M, Muntoni A, Gessa G. Mesolimbic dopaminergic reduction outlasts ethanol withdrawal syndrome: evidence of protracted abstinence. Neuroscience. 1996;71(2):411–415. [PubMed]
22. Weiss F, Porrino LJ. Behavioral neurobiology of alcohol addiction: recent advances and challenges.Journal of Neuroscience. 2002;22(9):3332–3337. [PubMed]
23. Wise RA, Newton P, Leeb K, Burnette B, Pocock D, Justice JB. Fluctuations in nucleus accumbens dopamine concentration during intravenous cocaine self administration in rats. Psychopharmacology.1995;120(1):10–20. [PubMed]
24. Wang G, Jiang N, He Z. Effects of scalp acupuncture on plasma ET-1, MDA and NO contents in the patient of cerebral infarction. Chinese Acupuncture and Moxibustion. 2001;21:241–242.
25. Han JS. Acupuncture: neuropeptide release produced by electrical stimulation of different frequencies. Trends in Neurosciences. 2003;26(1):17–22. [PubMed]
26. Han JS, Chen XH, Sun SL, et al. Effect of low- and high-frequency TENS on Met-enkephalin-Arg-Phe and dynorphin A immunoreactivity in human lumbar CSF. Pain. 1991;47(3):295–298. [PubMed]
27. Han JS, Ding XZ, Fan SG. The frequency as the cardinal determinant for electroacupuncture analgesia to be reversed by opioid antagonists. Sheng Li Xue Bao. 1986;38(5):475–482. [PubMed]
28. Han JS. Acupuncture and endorphins. Neuroscience Letters. 2004;361(1–3):258–261. [PubMed]
29. Han JS, Zhang RL. Suppression of morphine abstinence syndrome by body electroacupuncture of different frequencies in rats. Drug and Alcohol Dependence. 1993;31(2):169–175. [PubMed]
30. Wen HL, Ho WKK. Suppression of withdrawal symptoms by dynorphin in heroin addicts. European Journal of Pharmacology. 1982;82(3-4):183–186. [PubMed]
31. Wu LZ, Cui CL, Tian JB, Ji D, Han JS. Suppression of morphine withdrawal by electroacupuncture in rats: dynorphin and κ-opioid receptor implicated. Brain Research. 1999;851(1-2):290–296. [PubMed]
32. Green PG, Lee NM. Dynorphin A-(1-3) attenuates withdrawal in morphine-dependent rats: effect of route of administration. European Journal of Pharmacology. 1988;145(3):267–272. [PubMed]
33. Cui CL, Wu LZ, Han JS. Spinal kappa-opioid system plays an important role in suppressing morphine withdrawal syndrome in the rat. Neuroscience Letters. 2000;295(1-2):45–48. [PubMed]
34. Markou A, Weiss F, Gold LH, Caine SB, Schulteis G, Koob GF. Animal models of drug craving.Psychopharmacology. 1993;112(2-3):163–182. [PubMed]
35. Wang B, Luo F, Xia YQ, Han JS. Peripheral electric stimulation inhibits morphine-induced place preference in rats. NeuroReport. 2000;11(5):1017–1020. [PubMed]
36. Shi XD, Ren W, Wang GB, Luo F, Han JS, Cui CL. Brain opioid-receptors are involved in mediating peripheral electric stimulation-induced inhibition of morphine conditioned place preference in rats.Brain Research. 2003;981(1-2):23–29. [PubMed]
37. Yoon SS, Kim H, Choi KH, et al. Acupuncture suppresses morphine self-administration through the GABA receptors. Brain Research Bulletin. 2010;81(6):625–630. [PubMed]
38. Lee B, Shim I, Lee H, et al. Morphine-induced locomotor response and Fos expression in rats are inhibited by acupuncture. Neurological Research. 2010;32(1):S107–S110.
39. Chu NN, Zuo YF, Meng L, Lee DYW, Han JS, Cui CL. Peripheral electrical stimulation reversed the cell size reduction and increased BDNF level in the ventral tegmental area in chronic morphine-treated rats. Brain Research. 2007;1182(1):90–98. [PMC free article] [PubMed]
40. Chu NN, Xia W, Yu P, Hu L, Zhang R, Cui CL. Chronic morphine-induced neuronal morphological changes in the ventral tegmental area in rats are reversed by electroacupuncture treatment. Addiction Biology. 2008;13(1):47–51. [PubMed]
41. Hu L, Chu NN, Sun LL, Zhang R, Han JS, Cui CL. Electroacupuncture treatment reverses morphine-induced physiological changes in dopaminergic neurons within the ventral tegmental area. Addiction Biology. 2009;14(4):431–437. [PubMed]
42. Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Controlled Clinical Trials. 1996;17(1):1–12. [PubMed]
43. Washburn AM, Fullilove RE, Fullilove MT, et al. Acupuncture heroin detoxification: a single-blind clinical trial. Journal of Substance Abuse Treatment. 1993;10(4):345–351. [PubMed]
44. Wells EA, Jackson R, Diaz OR, Stanton V, Saxon AJ, Krupski A. Acupuncture as an adjunct to methadone treatment services. American Journal on Addictions. 1995;4(3):198–214.
45. Zhang B, Luo F, Liu C. Treatment of 121 heroin addicts with Han’s acupoint nerve stimulator. Chinese Journal of Integrated Traditional and Western Medicine. 2000;20(8):593–595. [PubMed]
46. Montazeri K, Farahnakian M, Saghaei M. The effect of acupuncture on the acute withdrawal symptoms from Rapid Opiate Detoxification. Acta Anaesthesiologica Sinica. 2002;40(4):173–177.[PubMed]
47. Wu JM, Wei DY, Luo YF, Xiang XY. Clinic research on heroin de-addiction effects of acupuncture and its potentiality of preventing relapse. Journal of Chinese Integrative Medicine. 2003;1(4):268–272.[PubMed]
48. Wen TQ, Yang ZJ, Lei XL, et al. Clinical application of acupuncture for treatment of heroin withdrawal syndrome. Chinese Acupuncture and Moxibustion. 2005;25(7):449–453. [PubMed]
49. Margolin A, Avants SK, Arnold R. Acupuncture and spirituality-focused group therapy for the treatment of HIV-positive drug users: a preliminary study. Journal of Psychoactive Drugs.2005;37(4):385–390. [PubMed]
50. Zeng X, Lei L, Lu Y, Wang Z. Treatment of heroinism with acupuncture at points of the Du Channel.Journal of Traditional Chinese Medicine. 2005;25(3):166–170. [PubMed]
51. Mu JP, Liu L, Hu J, Xu P. Clinical study on electroacupuncture at Jiaji (EX-B2) for interfering protracted withdrawal syndrome in the patient of heroin dependence. Chinese Acupuncture and Moxibustion. 2005;25(9):599–602. [PubMed]
52. Bearn J, Swami A, Stewart D, Atnas C, Giotto L, Gossop M. Auricular acupuncture as an adjunct to opiate detoxification treatment: effects on withdrawal symptoms. Journal of Substance Abuse Treatment.2009;36(3):345–349. [PubMed]
53. Birch S, Hesselink JK, Jonkman FAM, Hekker TAM, Bos A. Clinical research on acupuncture: part 1. What have reviews of the efficacy and safety of acupuncture told us so far? Journal of Alternative and Complementary Medicine. 2004;10(3):468–480.
54. Ernst E, White AR. Prospective studies of the safety of acupuncture: a systematic review. American Journal of Medicine. 2001;110(6):481–485. [PubMed]

Frances Kalfus is a Licensed Acupuncturist and has been practicing for thirty years in the San Francisco Bay Area. She has a private practice in Berkeley and has treated workers’ compensation patients spanning those years. She was trained by NADA (National Acupuncture Detoxification Association) in 1986 and has worked in clinics with drug addicted clients. Contact her at (510) 558-1911.

Back to Roundtable



Quick A-Z Index Search: A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z
Like to contribute? Please send your tips, ideas, A-Z topics or corrections to the editor.