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. 2023 Jul 28;12(3):100976. doi: 10.1016/j.imr.2023.100976

Acupuncture-related therapies for protracted opioid abstinence syndrome:A systematic review and meta-analysis

Lu Ding a, Cui Li a, Peiming Zhang e, Chen Chen a, Jie Zhan b,c, Jinchun Zeng d,⁎, Liming Lu a,⁎
PMCID: PMC10448024  PMID: 37637184

Abstract

Background

An increasing amount of clinical evidence of acupuncture's effect on protracted opioid abstinence syndrome (POAS) has emerged in recent years. The aim of this study was to evaluating the evidence of efficacy of acupuncture for POAS. clinical and scientific research work.

Methods

Four English-language databases (PubMed, Medline, Embase, Cochrane Libraries) and three Chinese-language databases (CNKI, WanFang and VIP Libraries) were searched, with coverage from database inception to March 31, 2022. Randomized clinical trials (RCTs) evaluating the effects of acupuncture and acupuncture-related therapies for prophylaxis or treatment of POAS were included. Data were screened and extracted independently according to pre-set tabular formats. RCT quality was assessed using risk of bias tool in the Cochrane Collaboration. The primary outcome was opiate withdrawal scale. The secondary outcomes are depression, anxiety for assessing protracted symptoms. The scores on the above scales are proportional to the severity of the symptoms.

Results

Twenty-eight trials met the inclusion criteria and provided data for the meta-analysis. A total of only 3 studies (11%) were judged to be low-risk overall due to various biases in them. Acupuncture-related therapy showed statistical differences in improving protracted withdrawal symptom scores compared with sham acupuncture (5 studies, Standard mean difference (SMD), -1.85, 95% CI [-3.21, -0.50], P = 0.007), western medicine(7 studies, SMD, -0.72, 95% CI [-1.22, -0.21], P = 0.005)and no treatment(3 studies, SMD,-2.26, 95% CI [-3.82, -0.69], P = 0.005)with high heterogeneity.

Conclusions

Acupuncture maybe safe and effective in relieving POAS individuals’ protracted withdrawal symptoms. However, the results of our review should be interpreted with caution because of the high risk of bias of the included trials.

Study registration

The protocol of this review has been registered at PROSPERO (CRD42022335505).

Keywords: Acupuncture, Protracted opioid abstinence syndrome, Systematic review, Meta-analysis

1. Introduction

According to the United Nations Office on Drugs and Crime World Drug Report 2022, about 300 million people worldwide will have used illicit drugs in 2021, a 22% increase from 2010. Opioids are the most widely used type of these drugs.1 Opioid addiction has become a major public health and social problem plaguing human health and social development. Treatment for opioid-dependent patients is divided into three stages: detoxification, rehabilitation and return to society.2 Addressing the high relapse rate after detoxification is the focus (and challenge) of current addiction treatment.3 Protracted opioid abstinence syndrome (POAS) is a syndrome characterized by various long-term physical symptoms and mental disorders in opioid addicts after detoxification treatment.4 These symptoms and disorders are an important cause of drug relapse.5

Opioid therapy is currently the classic detoxification therapy for POAS. However, the side effects of opioid therapy can emerge when dosage is reduced or discontinued, and patients are prone to sleep disturbance, depression, anxiety, pain, diarrhea and opioid cravings.6,7 As such, there is an urgent need for a way to eradicate the series of protracted syndromes after detoxification.

Since the introduction of acupuncture for drug addiction in the 1970s, this therapy has spread throughout the world. The safety, minimal side effects, efficaciousness and other advantages have attracted the attention of addiction researchers.8,9 Upon continuous in-depth research by many scholars, it has been found that not only is acupuncture effective for post-withdrawal symptoms, but also that transcutaneous electrical acupoint stimulation (TEAS), auricular acupressure, and warm moxibustion therapy have also produced promising experimental and clinical results.10,11 This has confirmed that acupuncture-related therapies can reduce symptoms such as depression and anxiety in patients with opioid dependence, and effectively reduce patients' methadone doses.12 However, few studies have focused on the POAS population, or paid sufficient attention to the heterogeneity of types of acupuncture. The improvement for specific withdrawal symptoms has also been overlooked.

In view of the increasing number of randomized controlled trials of acupuncture-related POAS treatment, yet the lack of a systematic study to integrate the data and the ensuing need for critical evaluation, we conducted a systematic review and meta-analysis of the available evidence. Our aim was to inform future clinical practice and scientific research.

2. Methods

This systematic review was registered in PROSPERO (CRD42022335505). This study was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions.13

2.1. Data sources and search strategy

Four English-language databases (PubMed, Medline (via PubMed), Embase, Cochrane Libraries) and three Chinese-language databases (CNKI, Wanfang and VIP Libraries) were searched for RCTs published from database inception through March 31, 2022. To search more comprehensively, we queried ClinicalTrials.gov and China Clinical Trials Registry two major clinical trial databases; reference lists of included papers were also manually screened. The search was limited to publications in English and Chinese. The search strategy consisted of three components: clinical condition (opioid/heroin/morphine addiction, protracted withdrawal symptoms/syndrome), intervention(acupuncture-related therapy) and study type (RCTs). The detailed search strategy is shown in Supplement 1.

2.2. Study selection

Studies: We comprehensively examined RCTs evaluating acupuncture-related therapies for POAS. We excluded non-randomized uncontrolled trials, case reports or case series, systematic reviews and meta-analyses, comments or letters, conference papers, dissertations, technological achievements, scientific research projects, cell culture or animal experiments, as well as studies published as abstracts only and certain cross-sectional study design trial types.

Participants: Study participants were adults (≥18 years old) with POAS who met any of the diagnostic criteria, such as the Diagnostic Criteria for Opioid Dependence in the International Classification of Diseases, 10th Edition (ICD-10) subcategory of mental and behavioural disorders developed by the World Health Organization,14 and several versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for opiate dependence.15,16 In addition, the diagnostic criteria for mental disorders caused by substance addiction in the Chinese Classification and Diagnosis of Mental Disorders (CCMD) are applied.17 All patients had completed mandatory detoxification treatment (and generally had been detoxified for at least a month). There were no restrictions on participants’ sex or race. Pregnant women and others with significant medical diseases were excluded, dependent on their actual clinical conditions.

Interventions: All types of acupuncture therapies are included in this study. According to the World Health Organization's definition, acupuncture includes literally piercing the corresponding acupuncture points with needles, and also the application of other types of stimulation to the acupuncture points, such as manual acupuncture(MA), electroacupuncture (EA), ear/auricular acupuncture (AA), auricular pressure, fire needling, scalp acupuncture(SA), laser acupuncture, transcutaneous electrical nerve stimulation (TENS), elongated needle, bee-sting therapy, catgut-embedding therapy, warming needle and acupoint injection.

The control group received either no treatment or a therapy other than acupuncture, such as sham acupuncture, conventional pharmacotherapy, psychosocial interventions, or other conventional interventions.

Outcome Measures: The primary outcome entails measuring persistent withdrawal symptoms’ intensity, and generally incorporates the Heroin Persistent Withdrawal Symptom Scale.18 Secondary outcomes were ratings of severity of anxiety, depression, sleep disturbance, cravings and other associated withdrawal symptoms. They generally used the HAMD/HAMA or SAD/SDS, or other tools suitable for the assessment of protracted symptoms, Pittsburgh Sleep Quality Index (PSQI), and Visual Analogue Scale/Score (VAS).

The exclusion criteria included duplicate publication, studies for which the full text was unavailable, or for which basic data from the study were not available after contacting the original authors.

2.3. Data extraction

All studies retrieved through the online database were imported into NoteExpress (software developed by the Guangzhou University of Chinese Medicine Library). Two reviewers (L. Ding and C. Li) independently identified studies by title and abstract according to the included and excluded criteria. Afterwards, the two authors independently screened through the full texts of the involved studies and cross-checked the results. The two reviewers (C. Chen and J. Zhan) extracted the characteristics of each eligible study (first author, year of publication, country, type of study, sample size, history of drug use, outcome indicators, Jadad score, and detailed descriptions of the intervention) independently according to predesigned forms. Any disagreements during screening or data extraction were resolved by discussion, or by a third investigator (L. M. L.) arbitrating the final decision when necessary.

2.4. Methodological quality assessment

Two of the authors (L. Ding and C. Chen) independently appraised the risk of bias for each included study with the Cochrane risk of bias assessment tool.19 Any disagreements were resolved by discussion and consensus with another reviewer (L. M. L.). The assessment of risk of bias included six parts: selection bias (random sequence generation, allocation concealment), blinding bias (blinding of participants and personnel), detection bias (blinding of outcome assessment), attrition bias (incomplete outcome data), reporting bias (selective reporting) and other bias. We considered funding sources, baseline imbalances, and other potential study design problems as other sources of bias. Each part in the assessment was judged as either low, unclear, or high risk of bias. When more than half of the evaluation entries were judged to be high-risk, the study could be judged as being low-quality overall.

2.5. Data synthesis and analysis

Data from included studies were analyzed by RevMan v. 5.4 (The Nordic Cochrane centre The Cochrane Collaboration, Copenhagen). Considering that AA and other acupuncture-related therapies are based on different treatment theories, we conducted a meta-analysis of auricular acupuncture data separately. For continuous variables, Mean Difference (MD) or Standard Mean Difference (SMD) was used for analysis. If data are reported at multiple points in time, the data reported immediately after the intervention is used. When the outcome indicator is measured by different assessment tools, the data is analyzed by SMD with 95% CIs; if the same assessment tool was used to measure the outcome, the data is analyzed by MD with 95% CIs.13

χ2 test was used to analyze the heterogeneity among the included study results, and I2 was used to quantitatively judge the heterogeneity.

Subgroup sensitivity analysis was used to explore potential sources of heterogeneity if the data were sufficient. Our initial planned subgroup analysis plan was based on different acupuncture methods.

A funnel plot was used to assess publication bias when the included study in one meta-analysis was more than 10.13

We also performed sensitivity analyses of the studies to test the robustness of their findings. If there was a significant difference in the studies’ risk of bias assessment, we would perform an exclusion analysis for these studies.

3. Results

3.1. Quantity of studies available

A total of 1104 potential studies were identified through the database search, from which 427 duplicates were removed and 472 were excluded after reading the titles and abstracts because they did not meet the inclusion criteria. An additional 169 studies were excluded due to not meeting the article type or unavailability of the full text. The remaining 28 studies were included in the systematic review and qualitative synthesis (Fig. 1).

Fig. 1.

Fig 1

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The flow diagram.

3.2. Characteristics of the included studies

These 28 studies involved 2463 patients with POAS, 1353 in the trial group and 1110 in the control group. The sample size for each group of studies ranged from 20 to 121. Twenty-seven of the studies included in the meta-analysis were conducted in China and one was conducted in the United Kingdom. Among the studies that met the inclusion and exclusion criteria, the vast majority of studies had subjects diagnosed with POAS by DSM-IV, and 9 studies had subjects diagnosed with POAS by ICD-10. Four studies has subjects diagnosed with POAS by CCMD.

Among the 28 RCTs included, the intervention with the highest frequency of use in acupuncture group was EA20, 21, 22, 23, 24, 25, 26, 27 (n = 8), followed by AA28, 29, 30, 31, 32, 33, 34, 35 (n = 8, here we refer to auricular acupoint pressing and auricular acupoint acupuncture both regard as auricular acupuncture), 4 studies36, 37, 38, 39 using MA, and another 340, 41, 42 using acupoint electrical stimulation on acupuncture points. In the control group setting, 11 studies27, 28, 29, 30,34,36,37,40,43, 44, 45 used Western medical controls, 8 of which27,34,36,37,40,43, 44, 45 were conventional pharmacotherapy, and 3 of which28, 29, 30 were conventional psychotherapy. Another 8 studies21, 22, 23,25,26,31,38,39,46 used a no-treatment control, 720, 21, 22, 24, 32, 33, 35, 41, 42 used a sham acupuncture, and 121 used both simulated acupuncture and no treatment control.

Fifteen studies21,27,29, 30, 31, 32,35, 36, 37, 38,40,41,45, 46, 47 reported protracted withdrawal symptom total scores, 1420, 21, 23, 24, 27, 33, 36, 37, 39, 40, 43, 44, 45, 47 reported protracted anxiety scores, 621, 24, 26, 43, 44, 47 reported protracted depression scores, 1320, 22, 25, 26, 27, 28, 29, 30, 36, 38, 40, 45, 46 reported protracted sleep disorder scores, 726, 29, 30, 38, 40, 45, 46 reported protracted withdrawal somatic symptom scores, and 720, 28, 35, 36, 37, 40, 41 reported crave scores. These studies’ characteristics are summarized in Supplement 2.

3.3. Acupuncture points

A total of 47 acupoints were used in 28 studies involving three types of acupuncture points: twelve meridian points, ear points, and head points, each of which was used between 1 and 16 times in different combinations. The number of acupoints used per POAS patient varied between 2 and 11 in the trials analyzed. The more frequently used meridian points were PC6, ST36, SP6, and HT7, and the most commonly used ear points were Shen Men, subcortical, and endocrine; the specific distribution of the other points is shown in Supplement 3.

3.4. Risk of bias of the included studies

The risk of bias in the included literature was assessed (Fig. 2A and B) as follows: (1) Random sequence generation: thirteen studies(46%) were rated as low risk due to the use of appropriate randomization methods, from which 9 used a random number table,23,26,27,35, 36, 37, 38,42,46 and 3 used the envelope method.21,22,25 Four studies(14%) were rated high risk due to their use of odd-even numbers40 and order of admission30,41,45 as randomized methods. The remaining studies(39%) mentioned randomization, but did not describe the specific randomization method, so they were rated as unclear. (2) Allocation concealment: Four studies (15%) were rated as high-risk because they had determined participant assignment based on admission sequence and the odd-even numbering method.30,40,41,45 The remaining studies did not mention allocation concealment, so they were rated as unclear. (3) Blinding of participants and outcome assessment: Four studies(15%) used blinding methods for both participants and outcome evaluators,30,35,41,47 and 2 studies were only blinded to participants.37,40 (4) Incomplete outcome data: eight studies (29%) reported case shedding and culling outcomes,35, 36, 37,39,41,43,45,47 and the remaining studies did not mention study outcome completeness. (5) Selective reporting: All of the studies reporting complete outcome indicators were rated as low-risk. (6) Other bias: None studies had any information on other risks-of-bias. In summary, a study can be considered high quality only if more than half of the entries (> 3) are rated as low risk, so only three studies meet this condition.35,37,41

Fig. 2.

Fig 2

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The risk of bias in the included studies.

3.5. Effects of the intervention

3.5.1. Acupuncture vs. sham acupuncture

A total of 9 studies20,21,24,32,33,35,41,42,47 used acupuncture versus sham acupuncture as control methods, and we conducted the following analysis according to the different outcome indicators.

3.5.1.1. Primary outcomes

Five studies assessed protracted withdrawal symptom scores. EA versus sham EA showed that EA was superior to sham acupuncture in improving protracted withdrawal symptoms (SMD=−1.85, 95% CI [−3.21, −0.50], P = 0.007, I2=94%, Fig. 3A). 21, 41, 47 The results of AA32,35 versus sham acupuncture showed that AA improved withdrawal symptoms more significantly than sham acupuncture (SMD=−0.19, 95% CI [−0.99, 0.62], P = 0.65, I2=82%, Fig. 3B).

Fig. 3.

Fig 3

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Acupuncture vs. sham acupuncture of the effects of the intervention.

3.5.1.2. Secondary outcomes

Four studies20,21,33,47 tested protracted anxiety symptom scores. The overall results showed that acupuncture-related therapy could significantly improve the symptoms of protracted anxiety compared with sham acupuncture (SMD=−1.66, 95% CI [−2.71, −0.62], P = 0.002, I2=94%, Fig. 3C). We excluded these 4 studies one by one to find the source of heterogeneity, found that 1 study47 was a major source of heterogeneity.

For crave scores, there were 3 studies mentioned.20,35,41The overall results showed that no significant difference between acupuncture-related therapy and sham acupuncture in reducing crave scores (SMD=−0.38, 95% CI [−2.50, 1.74], P = 0.73, I2=99%, Fig. 3D).

3.5.2. Acupuncture vs. western medicine

A total of 11 studies27, 28, 29, 30,34,36,37,40,43, 44, 45 used acupuncture versus western medicine as control methods.

3.5.2.1. Primary outcomes

Seven studies assessed on protracted anxiety symptom scores. Five27,36,37,40,45 used acupuncture-related treatments, and two29,30 used AA. The overall results showed that acupuncture-related treatment improved protracted withdrawal symptoms better than western medicine (SMD=−0.72, 95% CI [−1.22, −0.21], P = 0.005, I2=86%, Fig. 4A) Both MA (SMD=−0.78, 95% CI [−1.67, 0.10], P = 0.08, I2=91%) and EA (SMD=−0.66, 95% CI [−1.40, 0.08], P = 0.08, I2=81%) showed equvalent effects on this outcome compared with western medicine. The results showed that AA improved protracted withdrawal symptoms than western medicine (SMD=−5.97, 95% CI [−7.46, −4.48], P<0.00001, I2=38%, Fig. 4B)

Fig. 4.

Fig 4

Fig 4

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Acupuncture vs. western medicine of the effects of the intervention.

3.5.2.2. Secondary outcomes

Six studies tested the effects of acupuncture for protracted anxiety symptom scores. The overall results showed that acupuncture-related therapy could significantly improve the symptoms of protracted anxiety symptom scores compared with sham acupuncture (SMD=−0.64, 95% CI [−1.06, −0.23], P = 0.002, I2=80%, Fig. 4C). MA showed superior effects compared to western medicine in improving protracted anxiety symptom score (SMD=−0.37, 95% CI [−0.59, −0.16], P = 0.0007, I2=0%).36,37,45 EA failed to show significant effects on the improvement of protracted anxiety symptom scores (SMD=−0.93, 95% CI [−1.96, 0.10], P = 0.08, I2=91%).27,40,43

Two studies43,44 evaluated protracted depressive symptom scores, and the result showed that EA was superior to western medicine in improving depressive symptoms (SMD=−0.95, 95% CI [−1.63, −0.26], P = 0.007, I2=42%, Fig. 4D).

Six studies assessed the effects of acupuncture on protracted sleep disorder scores and showed that acupuncture-related therapy could significantly improve the symptoms of protracted sleep disorder scores compared with western medicine (SMD=−0.55, 95% CI [−1.05, −0.05], P = 0.03, I2=77%, Fig. 4E). There were no significant difference in the improvement of protracted sleep disorder scores between MA and western medicine (SMD=−0.40, 95% CI [−0.93, 0.14], P = 0.15, I2=75%, Fig. 4E).27,36,45 AA could significantly improve the symptoms of protracted sleep disorder scores compared with western medicine (SMD=−2.04, 95% CI [−2.25, −1.82], P<0.00001, I2=0%, Fig. 4F).29,30

Four studies showed that acupuncture-related therapy could significantly improve the symptos of protracted somatic scores with sham acupuncture (SMD=−0.66, 95% CI [−0.89, −0.43], P<0.00001, I2=88%, Fig. 4G).29,30,40,45

The results of four studies showed no significant difference between acupuncture-related therapy and western medicine in improving craving (SMD=−0.17, 95% CI [−0.47, 0.12], P = 0.26, I2=36%, Fig. 4H). 28, 36, 37, 40

3.5.3. Acupuncture vs. no treatment

A total of 9 studies21, 22, 23,25,26,31,38,39,46 used acupuncture versus no treatment as control methods.

3.5.3.1. Primary outcomes

The results of three RCTs showed that acupuncture-related treatment improved protracted withdrawal symptoms better than no treatment (SMD=−2.26, 95% CI [−3.82, −0.69], P = 0.005, I2=93%, Fig. 5A).21,38,46

Fig. 5.

Fig 5

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Acupuncture vs. no treatment of the effects of the intervention.

3.5.3.2. Secondary outcomes

Three included studies showed that acupuncture-related treatment improved protracted anxiety symptom scores better than no treatment (SMD=−1.63, 95% CI [−2.17, −1.08], P<0.00001, I2=55%, Fig. 5B).23,24,39

Three RCTs results showed that acupuncture-related treatment improved protracted depressive symptom scores better than no treatment (SMD=−2.31, 95% CI [−3.67, −0.95], P = 0.0008, I2=92%, Fig. 5C).21,24,26

Five studies showed that acupuncture-related treatment improved protracted sleep disorder scores better than no treatment (SMD=−2.77, 95% CI [−3.64, −1.91], P<0.00001, I2=84%, Fig. 5D).22,25,26,38,46

The results of three studies showed that acupuncture-related treatment improved protracted somatic symptom scores better than no treatment (SMD=−1.26, 95% CI [−1.68, −0.83], P<0.00001, I2=32%, Fig. 5E). 26,38,46

3.6. Sensitivity analysis

This review was evaluated based on the methodological quality of the included literature, and tested again after excluding low-quality literature. The findings showed that the results derived from this study's indicators were not affected by the methodological quality. This indicated that their combined results were generally stable and reliable.

3.7. Publication bias analysis

Because a funnel plot can only be applied if there are at least 10 included studies, however, less than 10 articles were included in the meta-analysis for each indicator in this paper, we did not conduct a publication bias analysis.

3.8. Adverse events due to acupuncture

No adverse events were reported in any of the included studies.

4. Discussion

4.1. Summary of results

Our review covered 28 RCTs involving 2463 patients with POAS. The results showed that acupuncture-related therapies might alleviate POAS patients’ withdrawal symptoms. Significant evidence of efficacy was observed in the acupuncture group in improving anxiety, depression, sleep disorders, and somatic symptoms, compared to that in the control group. However, there was not enough evidence to support the idea that acupuncture mitigates cravings. This observation is generally consistent with the results of previous studies.48, 49, 50, 51

4.2. Analysis of sources of heterogeneity

The heterogeneity in this study was generally higher than 50%, which we speculated was caused by some factors affecting the efficacy of acupuncture. It is generally accepted that the composition of an acupuncture protocol includes many factors which will affect the final effect such as the types of needle, the acupuncture points selected, the course of treatment, and the doctor's qualifications. Therefore, each of these factors served as a source of heterogeneity in the acupuncture meta-analysis. But further subgroup analysis was not feasible, due to the limited amount of literature.

4.3. Comparison to similar studies

The present study has shown considerable advantages over previous reviews on sample inclusion and bias assessment.51, 52, 53 The first is that this review update incorporates research from the years 2021 and 2022.46 Secondly, we targeted patients with protracted withdrawal syndrome, rather than patients with opioid use disorder (OUD). When previous reviews used Jaded scores for quality assessment, the number and quality of trials were too low to draw valid conclusions about acupuncture's effectiveness in treating patients with psychological symptoms associated with opioid addiction; low-quality studies accounted for 62.5% of the total included studies 0.53 However, in our study, low-quality studies with Jaded scores below 3 accounted for 46.4% (seen in Table 1 of Appendix 2). This confirms that study design has improved since the publication of the previous systematic review. However, the need to manually pierce acupuncture points during acupuncture treatment complicates the implementation of double-blind interventions. Although many sham-needle devices have been developed, there are still none that enable complete blinding of physicians and patients.

The treatment sessions in all studies were generally concentrated in a range of 20–30 days. Most studies using auricular acupressure or AA entailed treatment once per day; those using EA or MA entailed treatment of approximately 20/30 min per session, 3–5 times per week. MA focused on a treatment duration of about 2 weeks to show clinical effects. Although there are no guidelines for the frequency and duration of acupuncture treatment for POAS, it can be tentatively inferred from our meta-analysis results that a treatment duration of more than two weeks can be utilized as a crucial outcome in a standardized clinical treatment protocol.

By summarizing the frequency of acupuncture point use, we found that the acupuncture points selected for the treatment of POAS mainly reflected "up and down matching points", such as the most frequent ones: PC6, HT7, ST36 and SP6. The former two are located in the upper extremities, while the latter two are located in lower extremities. According to modern medicine, acupuncture stimulation of PC6, ST36 and other points can cause the release of Substance P (SP), locally and in brain areas. This activates the body's positive immunity, and because Substance P is related to opioid receptors,54 dopamine and serotonin signaling pathways, acupuncture can improve POAS patients' protracted withdrawal symptoms and psychological dependence by regulating humoral-immune functions.55,56

4.4. Implications for clinical practice and future research

At present, the specific acupoint group and dominant acupoints in acupuncture treatment for POAS remain controversial. As such, multi-center, large-sample, high-quality, double-blind RCTs are needed to resolve these controversies. In addition, comprehensively judging the therapeutic effect of acupuncture treatment on POAS would require improved systematic study of psychological cravings and long-term recurrence rates in POAS patients treated by acupuncture.

4.5. Research strengths and limitations

To our knowledge, this is the first study to focus on lasting withdrawal symptoms in addiction patients, rather than covering the entire detoxification phase. This allowed us to conduct more stringent inclusion/exclusion criteria for our meta-analysis, and to provide a complete overview. Secondly, we cover a wide variety of acupuncture modalities that will inform clinical practice. This research will inject inspiration and ideas into the most difficult problem in drug rehabilitation work—relapse.

This study has several limitations. Firstly, there are large differences in the population characteristics of the literature included, mainly due to regional differences. Most of the literature is from China, which may have introduced regional bias. Second, all of the included studies covered topics pertaining to acupuncture in some fashion, such as EA, AA, and traditional body acupuncture, and were analyzed together without classification. More research on this is needed to comprehensively assess which acupuncture modality is most effective for POAS. Finally, previous reviews have shown that acupuncture can be effective in treating opioid use disorder; EA can alleviate cravings for opioids and depression, and TEAS can mitigate symptoms of insomnia and anxiety.52 Given these findings, different acupuncture points and acupuncture techniques may have caused significant bias in this meta-analysis’ conclusions. Due to the limited number of studies, we did not perform a subgroup analysis of the different acupuncture modalities, or of acupoint selection. However, the heterogeneous effects of different acupuncture techniques warrant consideration in practical clinical applications.

4.6. Conclusion

Recent evidence identified from this review suggests that acupuncture-related therapies can alleviate POAS patients’ withdrawal symptoms. However, this review's conclusions are limited by the low quality of the included studies. Future multi-center RCTs with rigorous methodological quality are needed to elucidate acupuncture's role in improving withdrawal symptoms in patients with POAS.

Author contributions

All authors participated in its design. L. Ding and C. Li drafted the manuscript. L. M. Lu and P. M. Zhang revised it. L. Ding, C. Li, and C. Chen participated in designing the search strategies. L. Ding and C. Chen conducted the electronic search. L. Ding and C. Li completed the screening of all articles. C. Chen and J. Zhan participated in the data extraction. L. Ding and C. Chen assessed the risk of bias and the quality of the evidence. L. Ding, J. Zhan, and C. Chen participated in data analyses. LM. Lu arbitrated any disagreements in the process of the study. All authors read and approved the final manuscript.

Conflicts of interest

The authors declare no conflicts of interest.

Funding

This study was supported by the National Administration of Traditional Chinese Medicine's Innovation Team and Talent Cultivation Program (ZYYCXTD-C-202004), the special project “Lingnan Modernization of Traditional Chinese Medicine” within the 2019 Guangdong Provincial Research and Development Program (2020B1111100008), the National Natural Science Foundation of China (82174527), and Guangzhou University of Chinese Medicine's Project of First Class Universities and High-level Dual Discipline. The funders had no influence on study design, data collection, analysis, decision to publish, or manuscript preparation.

Ethical statement

On account of the characteristics of systematic review and meta-analysis, ethical approval was not required.

Data availability

The data supporting this study's findings are available within the article.

Footnotes

Supplementary material associated with this article can be found, in the online version, at doi:10.1016/j.imr.2023.100976.

Contributor Information

Jinchun Zeng, Email: tcm_zjc@126.com.

Liming Lu, Email: lulimingleon@126.com.

Appendix. Supplementary materials

mmc1.pdf (474.4KB, pdf)

References

  • 1.World Drug Report 2022 Home Page. [(accessed on 18 August 2022)]. Available online. Updated 2022. https://www.unodc.org/unodc/data-and-analysis/world-drug-report-2022.html.
  • 2.Lulin Z. Research on the construction of prevention system for drug addicts returning to society based on the perspective of social work. Dynam Social Sci. 2022;70(10):34–38. [Google Scholar]
  • 3.Taobiao Q., Lexi L., Yuan T., Jie C. Thoughts on follow-up care and countermeasures of forced isolation drug addicts returning to society. Justice China. 2018;(12):84–90. [Google Scholar]
  • 4.Dunn K.E., Huhn A.S., Bergeria C.L., Gipson C.D., Weerts E.M. Non-Opioid Neurotransmitter Systems that Contribute to the Opioid Withdrawal Syndrome: a Review of Preclinical and Human Evidence. J Pharmacol Exp Ther. 2019;371(2):422–452. doi: 10.1124/jpet.119.258004. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Pergolizzi J.J., Raffa R.B., Rosenblatt M.H. Opioid withdrawal symptoms, a consequence of chronic opioid use and opioid use disorder: current understanding and approaches to management. J Clin Pharm Ther. 2020;45(5):892–903. doi: 10.1111/jcpt.13114. [DOI] [PubMed] [Google Scholar]
  • 6.Zhang T., He X., Wu L., Feng X., Yang Y., Deng L. Electro-acupuncture combined methadone for withdrawal symptoms of opioid addiction: a protocol for systematic review and meta-analysis. Acupunct Electrother Res. 2021;46(4):419–432. doi: 10.3727/036012921X16237619666094. [DOI] [Google Scholar]
  • 7.Volkow N.D., Jones E.B., Einstein E.B., Wargo E.M. Prevention and treatment of Opioid misuse and addiction: a review. Jama Psychiat. 2019;76(2):208–216. doi: 10.1001/jamapsychiatry.2018.3126. [DOI] [PubMed] [Google Scholar]
  • 8.Wen H., Wei X., Ge S., et al. Clinical and economic evaluation of acupuncture for Opioid-dependent patients receiving methadone maintenance treatment: the integrative clinical trial and evidence-based data. Front Public Health. 2021;9 doi: 10.3389/fpubh.2021.689753. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Wen H., Chen R., Zhang P., et al. Acupuncture for Opioid dependence patients receiving methadone maintenance treatment: a network meta-analysis. Front Psych. 2021;12 doi: 10.3389/fpsyt.2021.767613. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Motlagh F.E., Ibrahim F., Rashid R.A., Seghatoleslam T., Habil H. Acupuncture therapy for drug addiction. Chin Med-Uk. 2016;11:16. doi: 10.1186/s13020-016-0088-7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Lin J.G., Chan Y.Y., Chen Y.H. Acupuncture for the treatment of opiate addiction. Evid-Based Compl Alt. 2012;2012 doi: 10.1155/2012/739045. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Chenfeng L., Danyang L., Huiwen W., Huangwei L., Zhaoyang Y. The research progress and situation analysis of traditional Chinese medicine for the treatment of protracted withdrawal symptoms. Chinese Journal of Drug Dependence. 2020;29(04):247–251. [Google Scholar]
  • 13.Higgins Jpt GS. Cochrane handbook for systematic reviews of interventions version 5.1.0. Updated 2011. www.cochrane-handbook.org.
  • 14.Centers For Disease Control and Prevention . National Center For Health Statistics; 2001. International Classification of Diseases 10th Revision. [Google Scholar]
  • 15.Association A.P. American Psychiatric Association; 2000. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, DSM-IV-R. [Google Scholar]
  • 16.Yang M., Liao Y., Wang Q., et al. Lifetime morbidity analysis of axis disorders in heroin addicts in the American Diagnostic and Statistical Manual of Mental Disorders (DSM-4) Chinese J Psych. 2013;(01):8–12. [Google Scholar]
  • 17.Shandong Science and Technology Press; 2001. CCMD-3 Chinese Classification and Diagnostic Criteria For Mental Disorders. [M] [Google Scholar]
  • 18.Chong L., Guozhu X., Jiwang Z. Investigation and study of post-detoxification auditory withdrawal symptoms in heroin-dependent patients. Chinese J Drug Dependence. 2000;(01):33–35. doi: 10.13936/j.cnki.cjdd1992.2000.01.014. [DOI] [Google Scholar]
  • 19.Yang W. Introduction to COCHRANE bias risk assessment tool. Chinese General Practice. 2019;22(11):1. [Google Scholar]
  • 20.Benguo Z., Fei L., Chongyue L., Al E. Treatment of 121 Heroin Addicts with Han′ s Acupoint Nerve Stimulator. Chinese Journal of Integrated Traditional and Western Medicine. 2000;(08):593–595. [PubMed] [Google Scholar]
  • 21.Mu J.P., 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] Zhongguo Zhen Jiu. 2005;25(9):599–602. [PubMed] [Google Scholar]
  • 22.Zhong-Chun Z., Jing-Ping M.U., Yan L., Lei Z., Jun H.U., Ping X.U. Clinical Observation on Treatment of Dyssomnia of Heroin Addicts after Detoxification by Electro-acupuncture. Shanghai J Acupunc Moxibus. 2005;24:6–8. doi: 10.3969/j.issn.1005-0957.2005.05.002. [DOI] [Google Scholar]
  • 23.Yan L., Hongli W., Yuanxing W., Wenguang H., Lei Z., Yuelai C. Clinical Observation of Electroacupuncture in Treating Withdrawal Anxiety in Heroin-dependent Patients. J Acupunct Tuina Sci. 2008;6(06):337–340. [Google Scholar]
  • 24.Jingping M., Li L., Jianming C., et al. Clinical Study on Electroacupuncture for Post-withdrawal Anxiety-depression Mood in Heroin Addicts. J Acupunct Tuina Sci. 2009;7(04):203–206. [Google Scholar]
  • 25.Lei Z., Wenguang H., Xiaoye W., Bowei A. Observations on the Therapeutic Effect of Acupuncture on Protracted Dyssomnia in Heroin Addicts. Shanghai J Acupunc Moxibus. 2009;28:191–194. [Google Scholar]
  • 26.Wenguang H., Yan L., Yuanxing W., Lei Z., Yuele C. Clinical observation of electro-acupuncture intervention on depression of heroin addicts after withdrawal. Chinese J Drug Abuse Preven Treatment. 2009;15(01):11–13. [Google Scholar]
  • 27.Liang Y., Juan C., Xi X.U., et al. Point Acupuncture Combined with Chinese medicine in the treatment of abstinence syndrome of Opioid drug addiction. J Clin Acupunc Moxibus. 2011;27(8):7–9. [Google Scholar]
  • 28.Huiming N., Fengying Q., Jiafu S., Donglin J. Analysis of curative effect of auricular acupoint compression on secondary amenorrhea and protracted withdrawal symptoms in drug addicts. Chinese J Drug Dependence. 2001;(03):204–206. [Google Scholar]
  • 29.Mei W., Hongliang Z., Yu L. Clinical observation on treatment of protracted withdrawal symptoms of heroin addicts by auricular acupoint pressing. Chinese J Drug Abuse Preven Treatment. 2004;(03):166–167. [Google Scholar]
  • 30.Cigong L., Weipeng L., Jianmei Z. Observation on the curative effect of auricular point sticking on the protracted withdrawal symptoms of opioid addicts. J Practical Med. 2006;(05):591–592. [Google Scholar]
  • 31.Xiao-Ge S., Guo-Long X., Zhao-Ming T., et al. Clinical Observation on 70 Cases of Heroin Protracted Withdrawal Symptoms Treated by Auricular Acupuncture. Chinese J Traditional Med Sci Technol. 2006;13:189–190. doi: 10.3969/j.issn.1005-7072.2006.03.026. [DOI] [Google Scholar]
  • 32.Liangyu W., Lihua Z., Fei L., Zhen Q., Linhua W., Meng X. Clinical observation of auricular acupoint pressing for treatment of protracted withdrawal symptoms in heroin addicts. New Chinese Med. 2011;43(11):97–98. [Google Scholar]
  • 33.Lihua Z., Dong L.P., Fei L., Linhua W., Chunmei N., Liangyu W. Effect of auricular acupoint pressing on Hamilton anxiety Scale in patients with protracted heroin withdrawal symptoms. J Guangxi University Chinese Med. 2015;18(02):11–13. [Google Scholar]
  • 34.Wen-Min N., Hai-Yang L., Yu-Heng Z. Application of Ear Acupuncture Therapy to Rehabilitation from Opiums Drugs Abstinence Syndrome. Shanghai J Acupunc Moxibust. 2000;(06):18–19. [Google Scholar]
  • 35.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. J Subst Abuse Treat. 2009;36(3):345–349. doi: 10.1016/j.jsat.2008.08.002. [DOI] [PubMed] [Google Scholar]
  • 36.Zengxiang-Ling Long-Ming L, Lu Yong-Hong E.A. Clinically controlled study on deintoxication of heroin dependence by acupuncture on points of the Governor Vessel. Chinese AcupuncMoxibus. 2004;24:385–387. [Google Scholar]
  • 37.Tun-Qing W., Zhao-Jun Y., Xi-Ling L., et al. Clinical application of acupuncture for treatment of heroin withdrawal syndrome. Chinese Acupunc Moxibus. 2005;25:449–453. [PubMed] [Google Scholar]
  • 38.Wen-Guang H., Yan L., Yu L., et al. Puncturing Jiaji (Ex-B2) points for protracted abstinence in Heroin addicts. Shanghai J Acupunc Moxibus. 2011;30(06):357–359. [Google Scholar]
  • 39.Yan L., Lei Z., Yu L., Bo C., Jing X., Address C.Y.A.A. Therapeutic efficacy observation on acupuncture for post-withdrawal syndrome of Heroin dependence. J Acupunct Tuina Sci. 2012;10:155–159. doi: 10.1007/sl1726-012-0593-x. [DOI] [Google Scholar]
  • 40.Hua W. Electrical stimulation of acupoints for treating continued syndrome in the Heroin dependent. Chinese AcupuncMoxibus. 2001;21:711–712. [Google Scholar]
  • 41.Zhipeng Q., Mingxing Q., Jisheng H., Liuzhen W. Effects of 2/100Hz HAN' S acupoint nerve stimulator on opioid addicts in community-based rehabilitation. Chinese J Drug Depend. 2010;19(03):185–190. doi: 10.13936/j.cnki.cjdd1992.2010.03.010. [DOI] [Google Scholar]
  • 42.Da M., Jisheng H., Heng D.Q., et al. Transcutaneous electrical acupoint stimulation for the treatment of withdrawal syndrome in heroin addicts. Chinese J Pain Med. 2014;20:696–703. doi: 10.3969/j.issn.1006-9852.2014.10.003. [DOI] [PubMed] [Google Scholar]
  • 43.Liuzhen W., Cailian C., Jisheng H. Reduction of methdone dosage and relief of depression and anxiety by 2/100Hz TENS for heroin detoxification. Chinese J Drug Dependence. 2001;(02):124–126. +140. [Google Scholar]
  • 44.Rong S., Xiuying W., Liqiang R., Al E. Channel balance-inducing treatment for late withdrawal syndrome of heroin dependence. Chinese AcupuncMoxibus. 2003;23:325–328. [Google Scholar]
  • 45.Jun R., Zhiyan L. Asihae. Clinical Study on Heroin Withdrawal Syndrome Treated by Scalp Acupuncture in Addicts. Chinese J Drug Abuse Preven Treatment. 2006;(04):205–208. [Google Scholar]
  • 46.Xiao-Yue G., Yan L., Li-Li H., Jie Y., You G., Cha-Yue X. Effect of Warm Needling on Protracted Withdrawal Symptoms in Heroin Addicts of Kidney Yang Deficiency Pattern. Shanghai J Acupunc Moxibus. 2021;40(10):1217–1222. [Google Scholar]
  • 47.Zhiwei Z., Shulan B., Zhichao Z. A randomized double-blind observation of protracted withdrawal syndrome treatment with HANS therapy instrument in Heroin addicts. Med J Chinese People's Health. 2008;(11):1115–1116. +1119. [Google Scholar]
  • 48.Ge S., Lan J., Yi Q., Wen H., Lu L., Tang C. Acupuncture for illicit drug withdrawal syndrome: a systematic review and meta-analysis. Eur J Integr Med. 2020;35 doi: 10.1016/j.eujim.2020.101096. [DOI] [Google Scholar]
  • 49.Chen Z., Wang R., Zhang M., Wang Y., Ren Y. Acupuncture combined with medication for opioid use disorder in adults: a protocol for systematic review and meta-analysis. BMJ Open. 2020;10(6) doi: 10.1136/bmjopen-2019-034554. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 50.Qingyang L., Qian W., Weiming H., Zhigang L. Advantages and characteristics of traditional Chinese medicine in the treatment of opioid addiction. Chin J Drug Depend. 2020;29(05):330–334. [Google Scholar]
  • 51.Jia-Xin Y., Yue-Lai C. Meta-analysis of acupoint stimulation on improving opioid protracted withdrawal symptoms. China J Traditional Chinese Med Pharmacy. 2016;31(10):4303–4306. [Google Scholar]
  • 52.Chen Z., Wang Y., Wang R., Xie J., Ren Y. Efficacy of Acupuncture for treating opioid use disorder in adults: a systematic review and meta-analysis. Evid-Based Compl Alt. 2018;2018:1–15. doi: 10.1155/2018/3724708. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 53.Boyuan Z., Yang C., Ke C., Xueyong S., Sheng L. Efficacy of acupuncture for psychological symptoms associated with Opioid addiction: a systematic review and meta-analysis. Evid-Based Compl Alt. 2014;2014:1–13. doi: 10.1155/2014/313549. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 54.Bo C., Mingyue L., Xue Z., Yangyang L., Yi G. The research progress of P material and acupuncture effect. Shanghai J Acupun Moxibus. 2014;33(01):82–87. doi: 10.13460/j.issn.1005-0957.2014.01.0082. [DOI] [Google Scholar]
  • 55.Sandweiss A.J., Vanderah T.W. The pharmacology of neurokinin receptors in addiction: prospects for therapy. Subst Abuse Rehabil. 2015;6:93–102. doi: 10.2147/SAR.S70350. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 56.Cui C.L., Wu L.Z., Li Y.J. Acupuncture for the treatment of drug addiction. Int Rev Neurobiol. 2013;111:235–256. doi: 10.1016/B978-0-12-411545-3.00012-2. [DOI] [PubMed] [Google Scholar]

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Data Availability Statement

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