Could brain surgery be the cure for opioid addiction?

Opioid overdoses claimed 49,860 lives in 2019, according to the CDC, and those overdose deaths — made worse by the strain of the pandemic — nearly doubled in 2020. Could brain surgery be the answer? Maybe. 

For many like James Fisher, a 36-year-old addict from West Virginia, winning the war against addiction seemed all but impossible. Fisher had used drugs since high school, moving from prescription drugs to street drugs like heroin once he could no longer obtain doctor’s notes or prescription pills from other drug users. Fisher had tried to get clean on his own, but it never stuck and he nearly lost his battle, overdosing four times. 

Gerod Buckhalter’s story was similar. The Morgantown, West Virginia man had battled drug addiction for two decades with multiple stints in rehab, followed by relapses and eventual overdoses. 

Fisher and Buckhalter’s circumstances weren’t particularly unique when it came to opioid addiction, but what separates the two men from the thousands of other addicts in the U.S. looking for hope is the experimental treatment they underwent. It’s called “deep brain stimulation” and involves a surgeon cutting two holes in the patient’s skull, roughly the size of a nickel, before inserting metal electrodes. Neuroscientist, Rob Malenka put it like this: 

“You have a big bowl of Jell-O and it’s opaque, and you have to take a chopstick and you have to place it so the tip of the chopstick is into the exact center of that bowl of Jell-O within two millimeters, without visualizing it.” 

For Buckhalter, the brain surgery has thus far, resulted in 600 days of clean and sober living.

“I didn’t find joy in living,” Buckhalter recalled. “When they turned it on, of course, I didn’t know what was going to happen in the future, but at that time I knew if I could continue to feel the way that I was feeling right then, that I would be OK.”

Deep brain stimulation has been used before for ailments such as Parkinson’s disease and epilepsy, but never before to treat addiction. 

“This is a treatment that allows you to dial down the anxiety, improve the mood, make people more in charge of their bodies, make them less fragile and susceptible. Ali Rezai, director of the Rockefeller Neuroscience Institute at West Virginia University, told The Washington Post. “So [you] make them more in control and then you allow other treatments to take effect.”

The brain stimulation target’s the reward centers of the brain and “normalizes” the brain’s dopamine levels that go crazy when opioids are introduced. As NBC News reports:

“When the surgery to implant the electrodes is complete, doctors switch on the deep brain stimulation device. For Fisher, the results were immediate and startling. The depression, anxiety and irritability are gone, replaced by a feeling of calm and comfort, like ‘a warm blanket.’

‘It’s like night and day,’ he said.

Fisher’s surgery was at the end of July. After four weeks, he told NBC News he feels “fantastic” with no craving to use drugs. Two months later, he is still sober.

‘I’m willing to do what it takes to get my brain back to normal,’ Fisher said. ‘I hope that I can get back to that period before I started using benzos. Just being naturally happy — enjoying music again, enjoying food again, enjoying seeing a smile on somebody’s face.’”

Using deep brain stimulation to treat addiction is still very much in a trial process. Fisher and Buckhalter are two of three people to undergo the surgery. The third patient relapsed and then dropped out of the trial. Though four more people are lined up for the first phase of the trial and a second phase with 10 patients will further test the procedure’s success in keeping people clean. 

With around 18.9 million people in the United States dealing with substance abuse, brain surgery isn’t a realistic solution for curing addiction. The brain’s circuitry is incredibly complex and still mysterious in many, many ways. Rezai hopes, however, that deep brain stimulation can help more people and ultimately provide more information about how to lessen the struggle of those addicted. 

“This is not a cure. And it’s not going to work for everybody,” Rezai said. “We need to study it more. But it’s for those who failed everything and they’re in a life-threatening situation. Our aim is to help those individuals, potentially, and learn more from the brain.”

Photos via Univ WV, NBC/YouTube, pxfuel

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