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Rédacteurs : Johan Nguyen, Jean-Luc Gerlier, Claude Pernice

drug addiction:

Toxicomanies : évaluation du sevrage par acupuncture

Articles connexes : - évaluation du taiji-qigong -

1. Systematic Reviews and Meta-Analysis

☆☆☆ Evidence for effectiveness and a specific effect of acupuncture
☆☆ Evidence for effectiveness of acupuncture
Limited evidence for effectiveness of acupuncture
Ø No evidence or insufficient evidence

1.1. Generic Acupuncture

1.1.1. Ge 2020 ☆

Ge SQ, Lan J, Yi Q, Wen H, … Tang CZ. Acupuncture for illicit drug withdrawal syndrome: A systematic review and meta-analysis. European Journal of Integrative Medicine. 2020;35. [212087]. doi

Introduction Illicit drug addiction remains a significant problem around the world. Acupuncture has been promoted as a treatment for drug withdrawal syndrome, but its effect remains controversial. The aim of this meta-analysis was to evaluate the efficacy and safety of acupuncture for illicit drug withdrawal syndrome.
Methods We searched four English databases and three Chinese databases from their inception to June 2019. The RCTs involving acupuncture for drug withdrawal syndrome were included in our study. The Cochrane assessment tool and the GRADE approach were used to assess the risk of bias and the quality of evidence. RevMan 5.3 software was used to analyse the data.
Results Thirty trials with 2391 participants were included in this study. The overall pooled results showed that compared to the control group, acupuncture could have a beneficial effect in the outcomes of withdrawal symptoms (n = 1160, SMD: -1.20, 95 % CI: -1.71 to -0.69, I2: 93 %), drug craving (n = 928, SMD: -0.80, 95 % CI: -1.38 to -0.23, I2: 94 %), anxiety (n = 1144, SMD: -2.32, 95 % CI: -3.00 to -1.64, I2: 95 %), depression (n = 489, SMD: -3.29, 95 % CI: -4.36 to -2.22, I2: 93 %), sleep (n = 649, SMD: -1.50, 95 % CI: -2.24 to -0.76, I2: 94 %). In total, 3 trials were assessed as low risk of bias. The quality of evidence assessed by GRADE was low or very low. Only 4 studies described adverse events.
Conclusion Acupuncture may alleviate illicit drug withdrawal syndrome. However, given the low or very low quality of evidence, more rigorous research is needed.

1.1.2. Chen 2018 ☆

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 Complement Alternat Med. 2018. [190051].

Objectives To assess the efficacy of acupuncture in treating opioid use disorder (OUD).
DesignSystematic review and meta-analysis. Methods: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, ProQuest Dissertation and Theses, Allied and Complementary Medicine Database (AMED), Clinicaltrials.gov, and who.int/trialsearch were searched from inception to 23 December 2017. The methodological quality of selected studies and the quality of evidence for outcomes were assessed, respectively, by the Cochrane risk of bias assessment tool and the GRADE approach. Statistical analyses were conducted by RevMan 5.3.
Results A total of nine studies involving 1063 participants fulfilled the inclusion criteria. The results showed that acupuncture could be more beneficial than no treatment/sham acupuncture in terms of changes in craving for opioid (MD -2.18, 95% CI -3.10 to -1.26), insomnia (MD 2.31, 95% CI 1.97 to 2.65), and depression (SMD -1.50, 95% CI -1.85 to -1.15). In addition, these findings showed that, compared to sham electroacupuncture (EA), EA had differences in alleviating symptoms of craving (SMD -0.50, 95% CI -0.94 to -0.05) and depression (SMD -1.07, 95% CI -1.88 to -0.25) and compared to sham transcutaneous acupoint electrical stimulation (TEAS), TEAS had differences in alleviating symptoms of insomnia (MD 2.31, 95% CI 1.97 to 2.65) and anxiety (MD -1.26, 95% CI -1.60 to -0.92) compared to no treatment/sham TEAS.
ConclusionsAcupuncture could be effective in treating OUD. Moreover, EA could effectively alleviate symptoms of craving for opioid and depression, and TEAS could be beneficial in improving symptoms of insomnia and anxiety. Nevertheless, the conclusions were limited due to the low-quality and small number of included studies.

1.1.3. Zhang 2018 ☆

Zhang Guang-Cai, Feng Qi-Fan, Zhou Xiao-Hui, Fu Wen-Bin. [Systematic Review of Acupuncture Therapy for Opioid-dependence Withdrawal Syndrome]. Journal of Guangzhou University of Traditional Chinese Medicine. 2018;(6):1016-1022. [182156].

Objective To evaluate the effectiveness and safety of acupuncture therapy for opioid-dependence withdrawal syndrome by systematic review.
Methods Quality evaluation and Meta-analysis were carried out in the domestic and oversea randomized control trials of acupuncture therapy for opioid-dependence withdrawal syndrome issued from January of 2000 to March of 2018.
Results A total of 11 randomized control trials involving 756 cases of opioid-dependence withdrawal syndrome were enrolled into the analysis. The Meta-analysis results showed that acupuncture combined with western medicine showed no significant difference in improving the scores of withdrawal symptoms(MD=-0.84, 95%CI[-2.38, 0.71]), body mass(MD=0.42, 95%CI[-2.13, 2.98])or Hamilton Anxiety Scale(HAMA)scores(MD=-4.33, 95%CI[-13.44, 4.78])as compared with western medicine alone(P > 0.05).Acupuncture had stronger effect on improving the scores of withdrawal symptoms(MD=-9.02, 95%CI[-13.37, -4.67])than non-intervention group(blank group), and acupuncture combined with western medicine showed significant difference in therapeutic effect on improving withdrawal symptoms(OR=3.39, 95%CI[1.56, 7.43]), lassitude dimension(MD=-0.05, 95%CI[-0.07, -0.03])and anorexia dimension(MD=-0.06, 95%CI[-0.08, -0.04])as compared with the control group(P < 0.05).
Conclusion Acupuncture has stronger effect on improving the scores of opioid-dependence withdrawal symptoms; acupuncture combined with western medicine exerts stronger therapeutic effect on improving the scores of withdrawal symptoms than western medicine alone, while its effects on the scores of withdrawal symptoms, HAMA scores and body mass are similar to western medicine alone.

1.1.4. Zhang 2016 ☆

Zhang Yang, Xu Wei, Song Xiao-ge, Zhang Yue, Chen Ling, Feng Jing. Acupuncture with methadone for heroin withdrawal syndrome: a meta-analysis of randomized controlled trials. Journal of Acupuncture and Tuina Science. 2016;14(1): 55-63. [186984].

Objectives To assess the efficacy of acupuncture plus Methadone in treating heroin withdrawal syndrome.
Methods According to the requirements of evidence-based medicine, the inclusion criteria, exclusion criteria and retrieval strategy were set for original documents. Randomized controlled trials (RCTs) involving acupuncture plus Methadone in treating heroin withdrawal syndrome were retrieved from China National Knowledge Infrastructure Database (CNKI), Wanfang Academic Journal Full-text Database (Wanfang), Chinese Biomedical Literature Database (CBM), Chongqing VIP Database (CQVIP), PubM ed, Cochrane Library and EMBASE. According to the Cochrane Handbook for Systematic Reviews of Interventions, each included trial was assessed strictly including risk of bias and quality evaluation. Meta-analysis and descriptive-analysis were conducted using the RevM an 5. 3 software.
Results A total of 8 trials involving 931 patients were included. Meta-analysis showed that there was no statistical significance [RR=1. 05; 95%CI (0. 99, 1. 11); P=0. 11] in comparing total effective rate between the acupuncture plus Methadone and Methadone alone; the cure rate of acupuncture plus Methadone was higher than that of Methadone alone [RR=1. 45; 95%CI (1. 19, 1. 78); P=0. 0003]; the relapse rate of the acupuncture plus Methadone was lower [RR=0. 691;95%CI (0. 60, 0. 80); P<0. 00001]. On the basis of these results, the method recommended by the Grading of Recommendations Assessment, Development and Evaluation (GRADE) was taken to evaluate the quality of the evidence. It showed that the level of the evidence was low and it was weakly recommended.
Conclusions According to the included trials, acupuncture plus Methadone in treating heroin withdrawal syndrome is more effective and better than Methadone alone, but it still needs more high-quality, large sample, and polycentric researches to confirm it.

1.1.5. Grant 2016 Ø

Grant S, Kandrack R, Motala A, Shanman R, Booth M, Miles J, Sorbero M, Hempel S. Acupuncture for substance use disorders: A systematic review and meta-analysis. Drug Alcohol Depend. 2016; 163:1-15. [158429].

Objectives This systematic review aims to estimate the effects of acupuncture for adults with substance use disorders (SUDs).
Methods We searched 7 electronic databases and bibliographies of previous studies to identify eligible randomized trials. Two independent reviewers screened citations, extracted data, and assessed risks of bias. We performed random effects meta-analyses. We assessed quality of evidence using the GRADE approach.
Results We included 41 studies with 5,227 participants. No significant differences were observed between acupuncture and comparators (passive controls, sham acupuncture, treatment as usual, and active interventions) at post-intervention for relapse (SMD -0.12; 95%CI -0.46 to 0.22; 10 RCTs), frequency of substance use (SMD -0.27; -2.67 to 2.13; 2 RCTs), quantity of substance use (SMD 0.01; -0.40 to 0.43; 3 RCTs), and treatment dropout (OR 0.82; 0.63 to 1.09; 22 RCTs). We identified a significant difference in favor of acupuncture versus comparators for withdrawal/craving at post-intervention (SMD -0.57, -0.93 to -0.20; 20 RCTs), but we identified evidence of publication bias. We also identified a significant difference in favor of acupuncture versus comparators for anxiety at post-intervention (SMD -0.74, -1.15 to -0.33; 6 RCTs). Results for withdrawal/craving and anxiety symptoms were not significant at longer follow-up. Safety data (12 RCTs) suggests little risk of serious adverse events, though participants may experience slight bleeding or pain at needle insertion sites.
Conclusions Available evidence suggests no consistent differences between acupuncture and comparators for substance use. Results in favor of acupuncture for withdrawal/craving and anxiety symptoms are limited by low quality bodies of evidence.

1.1.6. Boyuan 2014 ☆

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 Complement Alternat Med 2014; [177364]

Objective This review systematically assessed the clinical evidence for and against acupuncture as a treatment for psychological symptoms associated with opioid addiction.
Methods The database was accessed from MEDLINE and China Knowledge Resource Integrated Database. We included all randomized clinical trials published in Chinese and English regardless of their controls. Meta-analysis was performed using the RevMan software, version 5.2. We conducted a literature search of 16 databases from their inception to January 2014.
Results Four studies from Western countries did not report any clinical gains in the treatment of psychological symptoms associated with opioid addiction. 10 of 12 studies from China have reported positive findings regarding the use of acupuncture to treat the psychological symptoms associated with opioid addiction. The methodological quality of the included studies was poor. The meta-analysis indicated that there was a significant difference between the treatment group and the control group for anxiety and depression associated with opioid addiction, although groups did not differ on opioid craving.
Conclusion This review and meta-analysis could not confirm that acupuncture was an effective treatment for psychological symptoms associated with opioid addiction. However, considering the potential of acupuncture demonstrated in the included studies, further rigorous randomized controlled trials with long followup are warranted.

1.1.7. Lin 2012 ☆

Lin JG, Chan YY, Chen YH. Acupuncture for the treatment of opiate addiction. Evid Based Complement Alternat Med 2012. [165928] Acupuncture is an accepted treatment worldwide for various clinical conditions, and the effects of acupuncture on opiate addiction have been investigated in many clinical trials. The present review systematically analyzed data from randomized clinical trials published in Chinese and English since 1970. We found that the majority agreed on the efficacy of acupuncture as a strategy for the treatment of opiate addiction. However, some of the methods in several included trials have been criticized for their poor quality. This review summarizes the quality of the study design, the types of acupuncture applied, the commonly selected acupoints or sites of the body, the effectiveness of the treatment, and the possible mechanism underlying the effectiveness of acupuncture in these trials.

1.1.8. Liu 2009 ☆

Liu TT, Shi J, Epstein DH, Bao YP, Lu L. A Meta-Analysis of Acupuncture Combined with Opioid Receptor Agonists for Treatment of Opiate-Withdrawal Symptoms. Cell Mol Neurobiol. 2009;29(4):449-54. [153147].

Objectives This review extends a prior meta-analysis of acupuncture's utility for treating opioid detoxification, addressing the efficacy of acupuncture when combined with allopathic therapies.
Methods Both English and Chinese databases were searched for randomized trials comparing acupuncture combined with opioid agonist treatment versus opioid agonists alone for treating symptoms of opioid withdrawal.
Results The methodological quality of each study was assessed with Jadad's scale (1-2 = low; 3-5 = high). Meta-analysis was performed with fixed- or random-effect models in RevMan software; the outcome measures assessed were withdrawal-symptoms score, relapse rate, side effects, and medication dosage. Withdrawal-symptom scores were lower in combined treatment trials than in agonist-alone trials on withdrawal days 1, 7, 9, and 10. Combined treatment also produced lower reported rates of side effects and appeared to lower the required dose of opioid agonist. There was no significant difference on relapse rate after 6 months.
Conclusions This meta-analysis suggests that acupuncture combined with opioid agonists can effectively be used to manage the withdrawal symptoms. One limitation of this meta-analysis is the poor quality of the methodology of some included trials. High-quality studies are needed to confirm findings regarding the side effects and medication dosage.

1.1.9. Behere 2009 Ø

Behere RV, Muralidharan K, Benegal V. Complementary and alternative medicine in the treatment of substance use disorders –a review of the evidence. Drug Alcohol Rev. 2009;28(3):292-300. [156480]

Issues Substance use disorders are chronic relapsing disorders, leading to significant impairment in psychosocial functioning. Conventional therapies have not been able to alter the outcome of these disorders significantly and frequent relapses continue to occur, despite the development of newer medications, like baclofen, ondansetron, etc. Hence, there is a need to look at complementary and alternate systems of medicine.
Approach This article is a review of the evidence for complementary and alternate systems of medicine in substance use disorders. Articles were searched using the Medical Subject Headings (MeSH) database of the PubMed search engine and further non-indexed information was obtained from the Google search engine. The article is organised in parts, each reviewing a different system of medicine in the following order–alternate medical systems, biologically based therapies, energy-based interventions and mind-body interventions; as classified by the National Center for Complementary and Alternative Medicine, National Institutes of Health, USA.
Key findings The currently available evidence is limited and not very encouraging. At present only acupuncture, herbal therapies and mind-body interventions have shown some positive results in human trials and hold promise for the future. Implications: This review emphasises the paucity of research into this important field especially the lack of rigorous human trials.
Conclusion More systematic studies are required before these systems of medicine can be widely recommended in the treatment of substance use disorders.

1.1.10. Jordan 2006 Ø

Jordan JB. Acupuncture treatment for opiate addiction: a systematic review. J Subst Abuse Treat. 2006;30(4):309-14. [141283] A review of the efficacy of acupuncture as treatment for opiate addiction, covering 33 years of reported literature in western scientific journals, was systematically undertaken. Some abstracts from Chinese language journals were also briefly reviewed. Supportive evidence often came from noncontrolled nonblinded methodologies. When well-designed clinical trials (randomized, controlled, single-blind methodologies) were used, there was no significant evidence for acupuncture being a more effective treatment than controls. Some of the current supportive evidence for efficacy came from Chinese journals that have not been translated into English yet.

1.1.11. Kim 2005 Ø

Kim YH, Schiff E, Waalen J, Hovell M. Efficacy of Acupuncture for Treating Cocaine Addiction. A Review Paper. J Addict Dis. 2005;24(4):115-32. [141053]. Acupuncture is being used in more than three hundred treatment facilities for treating substance abuse including cocaine addiction. Previous review papers could not evaluate the role of acupuncture for treating cocaine addiction because of lack of clinical trials at the time. Since then, several important studies were conducted in the field. This paper reviews existing clinical trials using acupuncture to treat cocaine addiction. The existing evidence fails to document the benefit of acupuncture in treating cocaine addiction as the sole treatment. Further efforts to document the efficacy of the NADA protocol to treat cocaine addiction as the sole treatment should be re-evaluated. There is a limited amount of evidence showing possible benefits of acupuncture when used as an adjunctive therapy to complement existing substance abuse treatment program. Future efforts should concentrate on systematic studies investigating the role of acupuncture as an adjunctive treatment for cocaine addiction. In addition, more formative research exploring the efficacy of different types and protocols of acupuncture treatments for cocaine addiction should be thoroughly investigated.

1.1.12. Mills 2005 Ø

Mills EJ, Wu P, Gagnier J, Ebbert JO. Efficacy of acupuncture for cocaine dependence: a systematic review and meta-analysis. Harm Reduct J. 2005;2(1). [135988]

BackgroundAcupuncture is a commonly used treatment option for the treatment of addictions such as alcohol, nicotine and drug dependence. We systematically reviewed and meta-analyzed the randomized controlled trials of acupuncture for the treatment of cocaine addiction.
Methods Two reviewers independently searched 10 databases. Unpublished studies were sought using Clinicaltrials.gov, the UK National Research Register and contacting content experts. Eligible studies enrolled patients with the diagnosis of cocaine dependence of any duration or severity randomly allocated to either acupuncture or sham or other control. We excluded studies of acupuncture methods and trials enrolling patients with polysubstance use or dependence. We abstracted data on study methodology and outcomes. We pooled the studies providing biochemical confirmation of cocaine abstinence.
ResultsNine studies enrolling 1747 participants met inclusion criteria; 7 provided details for biochemical confirmation of cocaine abstinence. On average, trials lost 50% of enrolled participants (range 0-63%). The pooled odds ratio estimating the effect of acupuncture on cocaine abstinence at the last reported time-point was 0.76 (95% CI, 0.45 to 1.27, P=0.30, I2=30%, Heterogeneity P=0.19).
ConclusionsThis systematic review and meta-analysis does not support the use of acupuncture for the treatment of cocaine dependence. However, most trials were hampered by large loss to follow up and the strength of the inference is consequently weakened.

1.1.13. Wu Bin 2003 ☆

Wu Bin , WenChunyi, Shi Jianlin , et al. [A meta-analysis of acupuncture for treatment of drug addiction]. chinese Acupuncture and Moxibustion. 2003;23(9):501. (chi). [119065]

Objectives To assess the effect of acupuncture therapy in the treatment of drug addiction.
Methods A systematic review of all the relevant randomized controlled trials (RCTs) were carried out. Randomized and quasi-randomized trials in patients with confirmed drug addiction are used to compare acupuncture with other therapies such as traditional medicine and psychological treatment.
Results Altogether seven complete randomized trials were collected, one paper is a trial of high quality and others are trials of low quality.
Conclusions Acupuncture in treatment of drug addiction may be effective. However, because of lower quality of methodology in most of these trials, higher rate of losing follow-up and great variability of acupuncture methods and selection controls, this conclusion has no enough evidence.

1.1.14. Li 2003 ~

Li Ying, Liang Fanrong, Li Jie . [Review on clinical randomized control study on acupuncture in drug withdrawal]. Journal of TCM. 2003;44(10):790. [122499].

1.2. Special Acupuncture Techniques

1.2.1. Auricular Acupuncture

1.2.1.1. Baker 2016 ☆

Baker TE, Chang G. The use of auricular acupuncture in opioid use disorder: A systematic literature review. Am J Addict. 2016;25(8):592-602. [190701].

Objectives Opioid use disorder (OUD) is a chronic disease with significant personal, societal, and public health consequences. Even for the minority who receive the most effective evidence-based treatments, morbidity, and mortality remain significant. These facts, along with the recovery movement calling for individualized, holistic, culturally sensitive care, have led to the exploration of adjunctive interventions including acupuncture. Despite hundreds of international trials, however, there is a lack of consensus regarding its efficacy in OUD due in large part to methodological issues of trials to date. In response to these issues, the National Acupuncture Detoxification Association (NADA) developed an operationalized manual auricular acupuncture protocol that has since become the most widely used in the US. This systematic review is the first to focus explicitly on randomized trials utilizing the NADA protocol as a complementary intervention to address OUD.
Methods The methods utilized to identify studies for inclusion are based on a 2009 protocol developed by the Cochrane Collaboration.
Results Four trials met inclusion criteria. Despite methodological issues, results indicate that while the NADA protocol may not be effective in reducing acute opiate craving or withdrawal, it may be effectively utilized as an adjunctive treatment to increase treatment retention and decrease methadone detoxification and maintenance dosages in OUD.
Conclusions Incorporation of the NADA protocol into existing evidence-based treatment approaches may facilitate recovery and, through its impact on treatment retention and completion, indirectly impact morbidity, and mortality in individuals with OUD. Given the limitations of the current review, conclusions are tentative and directions for future research are discussed.
1.2.1.2. Lua 2012 Ø

Lua PL, Talib NS. The effectiveness of auricular acupuncture for drug addiction: a review of research evidence from clinical trials. ASEAN Journal of Psychiatry. 2012; 13(1):55-68. [160661].

Objectives This review aims to compile and evaluate all available randomised controlled trials (RCTs) of auricular acupuncture (AA) treatment in drug addiction population with emphasis on the length of treatment course, needlepoints, outcome measures, reported side-effects and overall outcomes.
Methods Science Direct, Medline and EBSCOhost databases were searched. From the year 1990 until 2010, only full-length English articles incorporating RCTs related to AA studies (needle-based only) in drug addiction such as heroin, morphine, methamphetamine and cocaine were included. Studies involving the usage of various methods of electro-acupuncture and investigations relating to cigarettesmoking or alcohol addiction were excluded.
Results Eight RCTs met all inclusion criteria comprising of 1,594 respondents (age = 19 - 46 years; male = 57% - 76%). Most were involved in cocaine addiction. Overall, trials were designed with brief periods of treatment course and utilised three to five standard National Acupuncture Detoxification Association (NADA) points (Sympathetic, Lung, Liver, Kidney and Shen men), but inconsistent sham points. All trials included urine toxicology test as the main outcome measure while data on side-effects incidence was insufficient.
Conclusions Overall, four of the RCTs reported positive outcomes although at this point, AA’s effectiveness and safety could not be substantially confirmed. For the future, high-quality RCTs of AA are urgently required to provide a clearer understanding on the usefulness of this complementary therapy in drug addiction treatment
1.2.1.3. Gates 2006 Ø

Gates S, Smith L, Foxcroft D. Auricular acupuncture for cocaine dependence. Cochrane Database Syst Rev. 2006;jan 25:CD005192. [141083].

Background Auricular acupuncture (insertion of acupuncture into a number, usually five, of specific points in the ear) is a widely-used treatment for cocaine dependence.
Objectives To determine whether auricular acupuncture is an effective treatment for cocaine dependence, and to investigate whether its effectiveness is influenced by the treatment regimen.
Methods Search strategy: We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004); MEDLINE (January 1966 to October 2004) , EMBASE (January 1988 to October 2004); PsycInfo (1985 to October 2004); CINAHL (1982 to October 2004); SIGLE (1980 to October 2004) and reference lists of articles. Selection criteria: Randomised controlled trials comparing a therapeutic regimen of auricular acupuncture with sham acupuncture or no treatment for reduction of cocaine use in cocaine dependents. Data collection and analysis: Two authors independently extracted data from published reports and assessed study quality using the Drug and Alcohol CRG checklist. All authors were contacted for additional information; two provided data. Separate meta-analyses were conducted for studies comparing auricular acupuncture with sham acupuncture, and with no treatment. For the main cocaine use outcomes, analyses were conducted by intention to treat, assuming that missing data were treatment failures. Available case analyses, using only individuals who provided data, were also conducted.
Main resultsSeven studies with a total of 1,433 participants were included. All were of generally low methodological quality. No differences between acupuncture and sham acupuncture were found for attition RR 1.05 (95% CI 0.89 to 1.23) or acupuncture and no acupuncture: RR 1.06 (95% CI 0.90 to 1.26) neither for any measure of cocaine or other drug use. However, the number of participants included in meta-analyses was low, and power was limited. Moderate benefit or harm is not ruled out by these results. Methodological limitations of the included studies may have also made the results open to bias.
Authors' conclusions There is currently no evidence that auricular acupuncture is effective for the treatment of cocaine dependence. The evidence is not of high quality and is inconclusive. Further randomised trials of auricular acupuncture may be justified.
1.2.1.4. Kunz 2004 Ø

Kunz S, Schulz M, Syrbe G, Driessen M. [Acupuncture of the ear as therapeutic approach in the treatment of alcohol and substance abuse: a systematic review] Sucht. 2004;50(3):196-203. [112172].

Objectives Acupuncture as a treatment of substance-related disorders has reached increasing acceptance. A systematic review of the available studies is provided to determine, if this trend is supported by the scientific evidence from RCT.
Methods A systematic literature search and critical appraisal of the studies was done.
Results Fourteen randomised controlled studies (RCT) of ear acupuncture in the treatment of withdrawal from opiate-, cocaine- or alcohol-dependent patients were identified. A meta-analysis of the studies based on effect size could not be performed because of varying objectives, methods, sample characteristics and different drop-out rates.
Conclusions The available scientific evidence does not support the efficacy of acupuncture in the treatment of withdrawal in opiate-, cocaine- and alcohol-dependent patients.
1.2.1.5. D'Alberto 2004 ∼

D'Alberto A. Auricular acupuncture in the treatment of cocaine/crack abuse: a review of the efficacy, the use of the national acupuncture detoxification association protocol, and the selection of sham points. Journal of Alternative and Complementary Medicine. 2004;10(6):985-1000. [136099] .

BackgroundThe United Kingdom has had a significant increase in addiction to and use of cocaine among 1629-year olds from 6% in 1998 to 10% in 2000. In 2000, the United Kingdom had the highest recorded consumption of “recent use” cocaine in Europe, with 3.3% of young adults. Acupuncture is quick, inexpensive, and relatively safe, and may establish itself as an important addiction service in the future.
AimTo select investigations that meet the inclusion criteria and critically appraise them in order to answer the question: “Is acupuncture effective in the treatment of cocaine addiction?” The focus shall then be directed toward the use of the National Acupuncture Detoxification Association (NADA) protocol as the intervention and the selection of sham points for the control group.
Methods Data sources: The ARRC database was accessed from Trina Ward (M. Phil. student) at Thames Valley University. AMED, MEDLINE® and Embase were also accessed along with “hand” searching methods at the British library. Inclusion and exclusion criteria: People addicted to either cocaine or crack cocaine as their main addiction, needle-acupuncture, single-double-blinded process, randomized subjects, a reference group incorporating a form of sham points. Exclusion criteria: use of moxibustion, laser acupuncture, transcutaneous electrical nerve stimulation (TENS) electroacupuncture or conditions that did not meet the inclusion criteria.Quality assessment: The criteria set by ter Riet, Kleijnen and Knipschild (in 1990); Hammerschlag and Morris (in 1990); Koes, Bouter and van der Heijden (in 1995), were modified into one set of criteria consisting of 27 different values.
ResultsSix randomized controlled trials (RCTs) met the inclusion criteria and were included in this review. All studies scored over 60 points indicating a relatively adequate methodology quality. The mean was 75 and the standard deviation was 6.80. A linear regression analysis did not yield a statistically significant association (n = 6, p = 0.11).
Conclusions This review could not confirm that acupuncture was an effective treatment for cocaine abuse. The NADA protocol of five treatment points still offers the acupuncturist the best possible combination of acupuncture points based upon Traditional Chinese Medicine. Throughout all the clinical trials reviewed, no side-effects of acupuncture were noted. This paper calls for the full set of 5 treatment points as laid out by the NADA to be included as the treatment intervention. Points on the helix, other than the liver yang points, should be selected as sham points for the control group.

2. Overviews of Systematic Reviews

2.1. Ronsley 2020 Ø

Ronsley C, Nolan S, Knight R, Hayashi K, Klimas J, Walley A, Wood E, Fairbairn N. Treatment of stimulant use disorder: A systematic review of reviews. PLoS One. 2020;15(6). [210388]. doi

AIMSStimulant use disorder contributes to a substantial worldwide burden of disease, although evidence-based treatment options are limited. This systematic review of reviews aims to: (i) synthesize the available evidence on both psychosocial and pharmacological interventions for the treatment of stimulant use disorder; (ii) identify the most effective therapies to guide clinical practice, and (iii) highlight gaps for future study.
METHODSA systematic database search was conducted to identify systematic reviews and meta-analyses. Eligible studies were those that followed standard systematic review methodology and assessed randomized controlled trials focused on the efficacy of interventions for stimulant use disorder. Articles were critically appraised using an assessment tool adapted from Palmeteer et al. and categorized for quality as 'core' or 'supplementary' reviews. Evidence from the included reviews were further synthesized according to pharmacological or non-pharmacological management themes.
RESULTS Of 476 identified records, 29 systematic reviews examining eleven intervention modalities were included. The interventions identified include: contingency management, cognitive behavioural therapy, acupuncture, antidepressants, dopamine agonists, antipsychotics, anticonvulsants, disulfiram, opioid agonists, N-Acetylcysteine, and psychostimulants. There was sufficient evidence to support the efficacy of contingency management programs for treatment of stimulant use disorder. Psychostimulants, n-acetylcysteine, opioid agonist therapy, disulfiram and antidepressant pharmacological interventions were found to have insufficient evidence to support or discount their use. Results of this review do not support the use of all other treatment options.
CONCLUSIONS The results of this review supports the use of contingency management interventions for the treatment of stimulant use disorder. Although evidence to date is insufficient to support the clinical use of psychostimulants, our results demonstrate potential for future research in this area. Given the urgent need for effective pharmacological treatments for stimulant use disorder, high-quality primary research focused on the role of psychostimulant medications for the treatment of stimulant use disorder is needed.
Acupuncture Overall, results from several studies have shown no benefit in the use of acupuncture for treatment of stimulant use disorder.

3. Clinical Practice Guidelines

⊕ positive recommendation (regardless of the level of evidence reported)
Ø negative recommendation (or lack of evidence)

3.1. Health Care for the Homeless Clinicians’ Network (HCH, USA) 2014 ⊕

Recommendations for the Care of Homeless Patients with Opioid Use Disorders. Health Care for the Homeless Clinicians’ Network. 2014:102p. [198262].

Encourage use of nonpharmacologic interventions, whether patients are receiving medication-assisted treatment or not: harm reduction therapy, peer mentoring, peer support groups, acupuncture, and stable housing with access to supportive services including employment assistance;

3.2. Haute Autorité de Santé (HAS, France) 2010 Ø

Prise en charge des consommateurs de cocaïne. Paris: Haute Autorité de Santé. 2010. 274P. Recommandations ; Argumentaire

L’acupuncture n’est pas spécifique de la prise en charge de l’addiction à la cocaïne. Il s’agit d’une technique thérapeutique adjuvante. En pratique clinique, un effet positif relaxant est constaté. Cependant, elle n’a d’effet ni sur le craving, ni sur l’abstinence (recommandations).
Les données disponibles dans la littérature sur l’effet de l’acupuncture montrent qu’en termes de rétention dans le programme et d’abstinence, l’acupuncture auriculaire n’a pas plus d’effet qu’une prise en charge sans acupuncture ou avec acupuncture traditionnelle (sham acupuncture). En termes de craving, l’effet est peu clair : une étude rapporte un effet bénéfique de l’acupuncture auriculaire et les autres études ne retrouvent pas cet effet. Certains facteurs psycho sociaux (satisfaction des participants, forte alliance thérapeutique) semblent avoir un impact sur la mise en évidence d’un effet avec cette technique (argumentaire).