It is estimated that untreated heroin addiction costs society up to US$20,000 per year per individual, and recent estimates show that deep brain stimulation (DBS) may be a cost-effective alternative for the treatment of addiction, particularly in patients with intractable heroin addiction (Stephen et al, 2012). The resistance to treatment and recidivism of many opioid-addicted individuals provide a compelling basis for developing novel therapeutic strategies. However, of this population, 40–60% will relapse following traditional treatment and rehabilitation within a year (McLellan et al, 2000).
Current treatments include cognitive behavioral therapy, replacement therapy (eg, methadone and buprenorphine), and antagonist therapy (eg, naltrexone). Individuals with heroin addiction lose an average of 18 years of potential life before age 65 years because of heroin overdose, chronic liver disease, or accidents (Smyth et al, 2007). Emergency department visits due to the nonmedical use of prescription opioids has increased from ~168 000 in 2004 to ~366 000 in 2011 (Crane, 2015). According to the National Institute on Drug Abuse, an estimated 4.2 million people (1.6% of the population in the United States) in 2011 had tried opioids at some time in their lives, with 23% converting to an opioid use disorder. Opioid addiction, including addiction to heroin, oxycodone, and other opioids, has markedly increased in the past decade. These results warrant further investigation to examine the therapeutic effects that STN HFS may have on relapse in humans with heroin addiction. STN HFS inhibited key brain regions, including the substantia nigra, entopeduncular nucleus, and nucleus accumbens shell measured using brain mapping analyses of immediate-early gene expression and produced a robust silencing of STN neurons as measured using whole-cell recording ex vivo. STN HFS prevented the re-escalation of heroin intake after abstinence in rats with extended access to heroin, an animal model of compulsive heroin taking. Here we provide preclinical evidence of the therapeutic potential of high-frequency stimulation of the subthalamic nucleus (STN HFS) for heroin addiction. Deep brain stimulation may represent a viable alternative strategy for the treatment of intractable heroin addiction, particularly in individuals who are resistant to traditional therapies. The cost and pervasiveness of heroin addiction, including resistance to recovery from addiction, provide a compelling basis for developing novel therapeutic strategies.
Opioid addiction, including addiction to heroin, has markedly increased in the past decade.
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