Are electroacupuncture and auricular acupuncture effective in reducing methodone consumption among heroin addicts?
Date of publication of randomized controlled trial: 2014
Design
Randomized controlled trial (RCT).
Participants
60 heroin addicts over the age of 20 (mean age: 36.15 years, male%: 81.7%) who fulfilled the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for opiate dependence and had been receiving methadone maintenance therapy (MMT) for more than one month. Patients were excluded if they were HIV positive; had received any antidepressant or neuroleptic medication; had received any acupuncture treatment during the previous 30 days; had developed severe adverse effects or had a history of events relating to acupuncture treatment; had any serious physical illness; had a significant risk of suicide; had an infection close to the site of the selected acupoints; were pregnant or were planning pregnancy; had bleeding disorders or were taking anticoagulant drugs.
Intervention
Electroacupuncture and auricular acupuncture were performed at LI4, ST36 and Ear Shenmen respectively. Needle retention lasted for 20 minutes and the treatment course was given twice weekly for 4 weeks.
Comparator
Comparison: Electroacupuncture and auricular acupuncture versus sham acupuncture.
Major Outcomes
Outcome 1: Change in daily consumption of methadone from baseline to week 2 (mg/day);
Outcome 2: Change in daily consumption of methadone from baseline to week 3 (mg/day);
Outcome 3: Change in daily consumption of methadone from baseline to week 4 (mg/day);
Outcome 4: Change in daily consumption of methadone from baseline to post-treatment (mg/day);
Outcome 5: Change in role limitations due to emotional problems (RE) scale scores of health-related quality of life assessed by the SF-36 from baseline to post-treatment;
Outcome 6: Change in bodily pain (BP) scale scores of health-related quality of life assessed by the SF-36 from baseline to post-treatment;
Outcome 7: Change in general health (GH) scale scores of health-related quality of life assessed by the SF-36 from baseline to post-treatment.
Settings
This trial was conducted in an outpatient setting.
Comparison    Electroacupuncture and auricular acupuncture versus sham acupuncture
Main Results
In electroacupuncture and auricular acupuncture group, there was a significant decrement in the daily consumption of methadone dosage of 3.66 mg/day at week 2 (p=0.002), 7.70 mg/day at week 3 (p<0.001), 9.95 mg/day at week 4 (p<0.001) and 8.10 mg/day (p=0.003) after treatment among heroin addicts. In contrast, there was no significant difference in the daily consumption of methadone dosage from baseline to post-treatment in sham acupuncture group. The reductions in methadone dosage differed significantly between two groups from week 2 to post-treatment. In addition, RE and GH scale scores assessed by the SF-36 significantly improved with electroacupuncture and auricular acupuncture while BP scores significantly improved with sham acupuncture. However, the change in scores of these three subscales in SF-36 did not differ significantly between two groups.
Comparison: Electroacupuncture and auricular acupuncture versus sham acupuncture among heroin addicts
Outcomes (units) No. of studies (Total number of participants) Mean (SD)/ No. of participants Heterogeneity test (I2) MD (95% CI) p value Overall quality of evidence*
Intervention Comparator
1 (mg/day) 1(60) -3.66 (6.06)/30 0.04 (4.31)/30 Not applicable as there is only one study. Not reported (-6.42 to -0.98) 0.008 High
2 (mg/day) 1(60) -7.70 (8.89)/30 1.29 (8.81)/30 Not applicable as there is only one study. Not reported (-13.57, -4.42) <0.001 High
3 (mg/day) 1(60) -9.95 (11.97)/30 0.95 (8.57)/30 Not applicable as there is only one study. Not reported (-15.99 to -5.23) <0.001 High
4 (mg/day) 1(60) -8.10 (13.37)/30 0.57 (7.86)/30 Not applicable as there is only one study. Not reported (-14.39 to -2.94) 0.004 High
5 (NA) 1(60) 62.22 (40.81)/30 50.00 (46.94)/30 Not applicable as there is only one study. Not reported 0.286 Low
6 (NA) 1(60) 80.17 (23.36)/30 74.33 (22.20)/30 Not applicable as there is only one study. Not reported 0.326 Low
7 (NA) 1(60) 54.83 (22.38)/30 47.67 (21.92)/30 Not applicable as there is only one study. Not reported 0.215 Low
Keys: SD: standard deviation; MD: mean difference; CI: confidence interval.
Comparison    Electroacupuncture and auricular acupuncture versus sham acupuncture
Main Results
In electroacupuncture and auricular acupuncture group, there was a significant decrement in the daily consumption of methadone dosage of 3.66 mg/day at week 2 (p=0.002), 7.70 mg/day at week 3 (p<0.001), 9.95 mg/day at week 4 (p<0.001) and 8.10 mg/day (p=0.003) after treatment among heroin addicts. In contrast, there was no significant difference in the daily consumption of methadone dosage from baseline to post-treatment in sham acupuncture group. The reductions in methadone dosage differed significantly between two groups from week 2 to post-treatment. In addition, RE and GH scale scores assessed by the SF-36 significantly improved with electroacupuncture and auricular acupuncture while BP scores significantly improved with sham acupuncture. However, the change in scores of these three subscales in SF-36 did not differ significantly between two groups.
Comparison: Electroacupuncture and auricular acupuncture versus sham acupuncture among heroin addicts
Outcomes (units) 1 (mg/day) 2 (mg/day) 3 (mg/day) 4 (mg/day) 5 (NA) 6 (NA) 7 (NA)
No. of studies (Total number of participants) 1(60) 1(60) 1(60) 1(60) 1(60) 1(60) 1(60)
Mean (SD)/ No. of participants Intervention -3.66 (6.06)/30 -7.70 (8.89)/30 -9.95 (11.97)/30 -8.10 (13.37)/30 62.22 (40.81)/30 80.17 (23.36)/30 54.83 (22.38)/30
Comparator 0.04 (4.31)/30 1.29 (8.81)/30 0.95 (8.57)/30 0.57 (7.86)/30 50.00 (46.94)/30 74.33 (22.20)/30 47.67 (21.92)/30
MD (95% CI) Not reported (-6.42 to -0.98) Not reported (-13.57, -4.42) Not reported (-15.99 to -5.23) Not reported (-14.39 to -2.94) Not reported Not reported Not reported
p value 0.008 <0.001 <0.001 0.004 0.286 0.326 0.215
Overall quality of evidence* High High High High Low Low Low
Keys: SD: standard deviation; MD: mean difference; CI: confidence interval.
Conclusion
Benefits
This study showed that there was a significant decrease in the daily consumption of methadone dosage from week 2 to the end of treatment in electroacupuncture and auricular acupuncture group. Compared to sham acupuncture, electroacupuncture and auricular acupuncture significantly reduced methadone dosage from week 2 to the end of treatment. Besides, for the health-related quality of life assessed by SF-36, RE and GH scale scores significantly improved with electroacupuncture and auricular acupuncture while BP scores significantly improved with sham acupuncture. However, the three subscale scores of SF-36 did not differ significantly between two groups. For outcomes 1 to 4, the overall quality of evidence is high. Further research is unlikely to have an important impact on our confidence in this estimate of effect. For outcomes 5 to 7, the overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Harms
All adverse events reported in the trial were mild. Two patients in the electroacupuncture and auricular acupuncture group reported slight bleeding at the site of acupuncture and one patient reported mild hand numbness. In the sham acupuncture group, one patient reported slight bleeding at the site of acupuncture.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/24871652
The synopsis is based on the following article:
Chan YY, Lo WY, Li TC, Shen LJ, Yang SN, Chen YH, et al. Clinical efficacy of acupuncture as an adjunct to methadone treatment services for heroin addicts: a randomized controlled trial. The American Journal of Chinese Medicine. 2014;42(03):569-86.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.