Noninvasive Vagal Nerve Stimulation for Opioid Use Disorder

Author: J Douglas Bremner1,2,3, Asim H Gazi4, Tamara P Lambert5, Afra Nawar4, Anna B Harrison4, Justine W Welsh1, Viola Vaccarino6,7, Kevin M Walton8, Nora Jaquemet1, Kellen Mermin-Bunnell1, Hewitt Mesfin1, Trinity A Gray1, Keyatta Ross1, Georgia Saks5, Nikolina Tomic4, Danner Affadzi1, Marom Bikson9, Amit J Shah3,6,7, Kelly E Dunn10, Nicholas A Giordano11, Omer T Inan4,5
1 Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta GA.
2 Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta GA.
3 Atlanta Veterans Affairs Healthcare System, Decatur GA.
4 School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA.
5 Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA.
6 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
7 Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta GA.
8 Clinical Research Grants Branch, Division of Therapeutics and Medical Consequences, National Institute on Drug Abuse, Bethesda, MD.
9 Department of Biomedical Engineering, The City College of New York, New York, NY.
10 Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore MD.
11 Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA.
Conference/Journal: Ann Depress Anxiety
Date published: 2023 Dec 12
Other: Volume ID: 10 , Issue ID: 1 , Pages: 1117 , Word Count: 218

Opioid Use Disorder (OUD) is an escalating public health problem with over 100,000 drug overdose-related deaths last year most of them related to opioid overdose, yet treatment options remain limited. Non-invasive Vagal Nerve Stimulation (nVNS) can be delivered via the ear or the neck and is a non-medication alternative to treatment of opioid withdrawal and OUD with potentially widespread applications.

This paper reviews the neurobiology of opioid withdrawal and OUD and the emerging literature of nVNS for the application of OUD. Literature databases for Pubmed, Psychinfo, and Medline were queried for these topics for 1982-present.

Opioid withdrawal in the context of OUD is associated with activation of peripheral sympathetic and inflammatory systems as well as alterations in central brain regions including anterior cingulate, basal ganglia, and amygdala. NVNS has the potential to reduce sympathetic and inflammatory activation and counter the effects of opioid withdrawal in initial pilot studies. Preliminary studies show that it is potentially effective at acting through sympathetic pathways to reduce the effects of opioid withdrawal, in addition to reducing pain and distress.

NVNS shows promise as a non-medication approach to OUD, both in terms of its known effect on neurobiology as well as pilot data showing a reduction in withdrawal symptoms as well as physiological manifestations of opioid withdrawal.

PMID: 38074313 PMCID: PMC10699253