Effectiveness of deep transcranial magnetic stimulation therapy in patients with opioid use disorder

Craving, a symptom that patients with Opioid Use Disorder experience even during remission and persists for many years, is the most common cause of relapses. The most important pillar of treatment is the prevention of relapses. For this purpose, pharmacologic and psychotherapeutic treatments are already in use and new treatments are being developed to prevent relapses. Transcranial magnetic stimulation (TMS), a non-invasive brain stimulation method, is one of the treatments that have recently been developed for this purpose. In this study, deep TMS (dTMS) treatment was applied to reduce the craving levels of patients with Opioid Use Disorder. In Pamukkale University Psychiatry, Alcohol and Substance Abuse Treatment Center (AMATEM), 55 patients with Opioid Use Disorder who agreed to participate in the study were randomly divided into 2 parallel groups. One group received active dTMS treatment in a double-blind manner, while the other group received sham TMS. Patients continued to use buprenorphine/naloxan (BuN) maintenance treatments started during the washout period during the study period. Patients in the active group received dTMS treatment via a double conical coil to the left dorsolateral prefrontal cortex (DLPFC) for 2 sessions per day, 5 days a week for 2 weeks, for a total of 20 sessions. The opioid craving levels of the patients included in the study were evaluated with the Opioid Craving Visual Analog Scale (OC-VAS) scale administered to the patients before clinical intervention, at the 1st week of clinical intervention, at the 2nd week after clinical intervention, and at the 1st and 2nd month after clinical intervention. Depression, anxiety and impulsivity levels of the patients were evaluated using Hamilton Anxiety Rating Scale (HADÖ), Hamilton Depression Rating Scale (HDRS), Barratt Impulsivity Scale (BIS-11) before the clinical intervention, at 2 weeks after the clinical intervention and at 2 months after the clinical intervention. Urinary opiate metabolite results of patients who were being treated and followed up in Pamukkale University Psychiatry, AMATEM department and who gave a urine drug test were also examined throughout the study. At the end of the study, 9 patients from the active group and 7 patients from the placebo group left the study. The study was terminated with 21 patients who received active TMS and completed the clinical intervention and 18 patients who received sham TMS. When the craving levels, depression, anxiety and impulsivity levels of the patients who were included in the study and completed the clinical intervention before the treatment, at the end of the treatment and after 2 months of follow-up were evaluated, it was found that the craving, depression, anxiety and impulsivity levels at the end of the treatment and at 2 months were significantly lower in both active and sham TMS groups compared to the craving, depression, anxiety and impulsivity levels of the patients in both active and sham groups before the treatment. It was found that the levels of craving, depression, anxiety and impulsivity were significantly lower in both active and sham TMS groups, but the amount of decrease in craving, depression, anxiety and impulsivity levels between active and sham TMS groups did not show a statistically significant difference. In the other phase of the study, patients who used other substances such as cannabis, cocaine, amphetamine, etc. in addition to opioids more than one times a month were excluded and the data of only opiate users were analyzed. Among the patients who used only opiates, 13 received active dTMS and 11 received sham TMS. When the data of this subgroup were analyzed, it was found that the decrease in the craving scores of the patients in the active dTMS group until the end of the 2nd month compared to the pre-treatment period showed a significant difference compared to the patients in the sham TMS group. dTMS treatment in patients with opioid use disorder is a field that has not yet been sufficiently studied and this is the first study investigating the efficacy of dTMS treatment with double conical coil in patients with opioid use disorder and more studies are needed to determine the efficacy of this treatment method