East Asian Arch Psychiatry 2016;26:70-6


Acupuncture for Detoxification in Treatment of Opioid Addiction
SLY Wu, AWN Leung, DTW Yew

Ms Sharon L. Y. Wu, BSc, MCM, School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
Prof. Albert Wing-Nang Leung, BSc, PhD, BCM, School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
Emeritus Prof. David Tai-Wai Yew, PhD, DSc, MD, Schools of Biomedical Sciences and Chinese Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.

Address for correspondence: Ms Sharon L. Y. Wu, Schools of Biomedical Sciences and Chinese Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China.
Tel: (852) 9616 0680; Email: sharonlywu@gmail.com

Submitted: 15 February 2016; Accepted: 17 May 2016

pdf Full Paper in PDF


Opioid is a popular drug of abuse and addiction. We evaluated acupuncture as a non-pharmacological treatment with a focus on managing withdrawal symptoms. Electrical stimulation at a low frequency (2 Hz) accelerates endorphin and encephalin production. High-frequency stimulation (100 Hz) up- regulates the dynorphin level that in turn suppresses withdrawal at the spinal level. The effect of 100-Hz electroacupuncture may be associated with brain-derived neurotrophic factor activation at the ventral tegmental area, down-regulation of cAMP response element-binding protein, and enhanced dynorphin synthesis in the spinal cord, periaqueductal grey, and hypothalamus. Clinical trials of acupuncture for the management of different withdrawal symptoms were reviewed. The potential of acupuncture to allay opioid-associated depression and anxiety, and its possible use as an adjuvant treatment were evident. A lack of effect was indicated for opioid craving. Most studies were hampered by inadequate reporting details and heterogeneity, thus future well-designed studies are needed to confirm the efficacy of acupuncture in opioid addiction treatment.

Key words: Acupuncture; Electroacupuncture; Heroin; Opioid-related disorders; Substance withdrawal syndrome


In the past 4 years (from 2012 to the third quarter of 2015), heroin has remained the most commonly abused drug in Hong Kong. According to the Central Registry of Drug Abuse, heroin use is reported by over 50% of reported abusers.1 Heroin abuse imposes a high risk of mortality2,3 and morbidity.4 Its combined use with alcohol or barbiturates may fatally depress respiration.5 Injection of the drug is associated with the risk of gangrene, blood clot formation, acquired immunodeficiency syndrome, hepatitis, tuberculosis, and sexually transmitted diseases. The sociological, psychological, and medical costs are high to both the individual and society.

Methadone maintenance therapy (MMT) has been prescribed in Hong Kong since 1972. Its ready availability as well as stable effect with long half-life make it the dominant treatment of detoxification.6 Nevertheless, MMT is a substitution therapy and contributes to a high relapse rate after detoxification.7,8 A prolonged reliance on a maintenance dose confers tolerance to its autonomic effects (constipation, urinary hesitancy, reduced libido and potency, perspiration).9 Combined use of methadone with other drugs imposes serious risk. As a result, other methods are being sought to improve treatment. The agonist-antagonist mix buprenorphine is thought to be a less addictive and safer substitute with fewer interactions with other euphoriant drugs.10,11 Nonetheless, respiratory depression may occur with therapeutic doses so it should be used with caution in patients with compromised respiratory function.12 Use of a symptomatic medication such as clonidine is hampered by its hypotensive and sedative effects.13 Tramadol and estazolam may cause various side-effects, with the latter having the potential to cause changes in behaviour.

Development of Acupuncture as a Treatment for Opioid Addiction

The application of acupuncture in addiction treatment commenced following an incidental discovery by Wen, a neurosurgeon in Hong Kong.14 In 1972, a 50-year-old male patient was admitted to Kwong Wah Hospital with brain concussion. He was known to have been abusing opium for 5 years and was offered cingulotomy for his drug abuse problem. Acupuncture anaesthesia was used instead of local anaesthesia. Acupuncture points employed were IL-4 and SI-3 (right hand), EH-4 and TB-9 (arm), as well as the auricular brainstem and Shenmen (神門). During electrostimulation of the acupuncture needles, the patient voluntarily reported complete disappearance of his withdrawal symptoms. Wen15 went on to pursue the plausible link between acupuncture and relief of withdrawal symptoms, and concluded that acupuncture could provide effective relief in heroin withdrawal syndrome.

Another milestone was the codification of the National Acupuncture Detoxification Association (NADA) protocol and establishment of its training procedure. Wen and Cheung’s protocol16 was introduced at the Lincoln Recovery Center in the Bronx, New York in 1974. The Director of the Center, Dr Michael O. Smith, founded the NADA and developed Wen and Cheung’s protocol16 into the well-known 5-point ear acupuncture protocol.17 Acupuncture points employed in the NADA protocol are bilateral ‘sympathetic’, ‘Shenmen’, ‘kidney’, ‘liver’, and ‘lung’. The protocol has since been introduced into many western clinical settings and approximately 30 countries worldwide. Training in its application has also gained recognition — individuals who complete 70 hours of NADA training are known as “acupuncture detoxification specialists”.18

During the abundant research into acupuncture analgesia since the late 1950s, it has become clear that acupuncture can induce an antinociceptive effect by accelerating the production and release of opioid peptides in the central nervous system (CNS). Han et al19,20 from Beijing Medical University, China, concluded that the antinociceptive effect was frequency-dependent, with low- frequency (2 Hz) stimulation accelerating production of endorphin and encephalin, and high-frequency stimulation (100 Hz) up-regulating the dynorphin level. Their finding that acupuncture precipitated release of endorphins led to the idea of using it to relieve withdrawal syndrome of addicts during abstinence.

Effect of Electroacupuncture on Relief of Withdrawal Syndrome: Animal Studies

Despite the original belief that 2 Hz should be more effective in reducing withdrawal, Han and Zhang21 later found that 2 Hz was only marginally effective in suppressing 2 of 5 withdrawal signs in rats, while all 5 signs were significantly reduced with 100-Hz electroacupuncture (EA).21,22 Dynorphin was shown to suppress withdrawal syndrome in heroin-dependent humans23 and morphine- dependent animals through the κ-opioid receptors in the spinal cord.24 Cui et al25 later revealed that spinal intrathecal administration of a κ-opioid receptor agonist trans-3,4- dichloro-N-methyl-N-[2-(1-pyrrolidinyl)-cyclohexyl]- benzenacetamide hydrochloride (U-50,488H, 2.5-10 μg) U-50488 suppressed naloxone-precipitated withdrawal syndrome. On the contrary, the κ-opioid antagonist nor- binaltorphimine (1.25-5 μg) induced naloxone-precipitated withdrawal syndrome in a dose-dependent manner. A single dose of dynorphin was effective in suppressing both withdrawal and tolerance in morphine-dependent mice.26 The findings of other studies22,25,27,28 suggested that an endogenous κ-agonist, probably dynorphin, suppresses morphine withdrawal at the spinal level.

These findings explained the immediate effect of a single EA treatment. Wang et al29 presented work on the cumulative effect. Multiple sessions of 100-Hz EA were more effective and long-lasting than a single session in suppressing morphine-induced withdrawal syndrome in rats. Hooke et al26 provided evidence that the effect of dynorphin on suppressing withdrawal could be enhanced by repeat dosing. A down-regulation of preprodynorphin (PPD) mRNA level in the spinal cord, periaqueductal grey matter and the hypothalamus was observed after injection of morphine, and reversed by multiple sessions of EA. Accompanied by down-regulation of the PPD mRNA level, up-regulation of cAMP response element-binding protein (p- CREB) was observed in 3 CNS regions, and was abolished by 100-Hz EA treatment.29 These findings indicate that acceleration of dynorphin synthesis and down-regulation of p-CREB may be implicated in the cumulative effect of multiple 100-Hz EA treatments for opioid detoxification.

Neurons containing dopamine (DA) in the ventral tegmental area (VTA), in particular the nucleus accumbens (NAc), and their target areas in the limbic forebrain play the most important role in the brain reward circuit. All drugs of abuse increase DA-mediated transmission in the NAc. Chronic morphine causes reduction in size of DA neurons in the VTA30 and reduces the dendritic spinal density of medium spiny neurons in the NAc.31 Hypofunction of DA neurons in the VTA is thought to contribute to acute and protracted opiate withdrawal.32 In rats with morphine withdrawal for 14 days, the ultrastructure of VTA DA neurons was altered and their size decreased.33,34 At the same time, the firing rate and burst firing of the VTA DA neurons were not altered with intravenous injection of morphine.35 Rat experiments showed that 100-Hz EA could suppress morphine withdrawal, facilitate recovery of VTA DA neurons and normalise their reactivity to morphine, and up-regulate brain-derived neurotrophic factor (BDNF) protein level in VTA.33,34 This implies that the detoxification effect of 100-Hz EA may be associated with endogenous BDNF activation.

Effect of Acupuncture on Relief of Withdrawal Syndrome: Clinical Studies

Depression and Anxiety

Psychological symptoms are the strongest factor that contributes to relapse from heroin withdrawal.36,37 Co- morbidity between substance abuse, depression, and anxiety is very common38 and many studies take depression and anxiety as the outcome measures. A meta-analysis of acupuncture for opioid addiction–associated depression by Zhang et al39 included 2 trials that compared the effects of acupuncture with placebo acupuncture and with no treatment. Their results showed a statistically significant benefit of acupuncture in alleviation of depressive symptoms compared with both placebo acupuncture and no treatment. From the included trials, Hou et al40 randomly assigned 60 addicts who fulfilled the ICD-10 criteria to an acupuncture or control group. The acupuncture group received needling on bilateral Neiguan (內關; PC-6), Shenmen (HT-7), Zusanli (足三里; ST-36), Sanyinjiao (三陰交; SP-6), Jiaji T 5-7 (夾脊穴; EX-T 5-7 ), and Shenshu (腎俞; BL-23), with EA of 3 to 5 Hz, sparse wave applied on Zusanli, Sanyinjiao, Jiaji T7, and Shenshu. The EA was performed daily for 20 minutes, 5 times a week for 3 weeks. The control group received no treatment. The acupuncture group showed significantly lower Hamilton Depression Rating Scale41 than the control group. In the second trial from the analysis, Mu et al42 evaluated the effects on anxiety and depression by randomising 120 heroin addicts who fulfilled the DSM-IV criteria to acupuncture on bilateral Neiguan, Shenmen, Zusanli, Sanyinjiao and Taichong (太冲; LR-3) [Group 1], bilateral Jiaji T5,9,11 and Shenshu (Group 2), sham electrostimulation group (Group 3), or control group (Group 4). For the first 2 groups, selected acupoints Neiguan, Shenmen, Zusanli and Sanyinjiao (Group 1), as well as Jiaji T5,11 and Shenshu (Group 2) received electrostimulation of 5 Hz, 5 mA for 20 minutes, 3 times a week for 10 weeks. The third group received sham stimulation on Zusanli, Sanyinjiao, and Jiaji T5,11 for 20 minutes, 3 times a week for 10 weeks. The control group received no treatment. For the 2 experimental EA groups, patient scores in the Zung Self-rating Depression Scale were lower than the sham and control groups (p < 0.05). Anxiety scores as indicated by the Zung Self-rating Anxiety Scale in the 2 EA groups were also lower than the sham and control groups (p < 0.01 and p < 0.05 respectively). The effect of acupuncture on depression did not significantly differ between the 2 EA groups. Nonetheless for anxiety, acupuncture Group 2 (who received regular needling on bilateral Jiaji T9 and EA on Jiaji T5,11 and Shenshu showed significant improvement compared with their Group 1 counterparts (i.e. regular needling on Taichong and EA on Neiguan, Shenmen, Zusanli, and Sanyinjiao) after 10 weeks of treatment.

In addition to the above study by Mu et al,42 a meta- analysis by Zhang et al43 pooled 7 more trials that examined the effect of acupuncture on opioid-associated anxiety. Acupuncture achieved a greater improvement than placebo acupuncture, drug,44,45 or no-treatment therapies,42,46 although no statistical difference was found for acupuncture with drug versus drug alone.47,48 The study duration ranged from 10 days to 10 weeks. Regardless of the plausible clinical effectiveness, most studies were hampered by their small study population, and lack of reporting of attrition rates and method of allocating patients. The studies also differed in their treatment regimen, type of waveforms if EA was the selected intervention, insertion depth (possibly due to different selected acupoints), and manipulation methods. This heterogeneity rendered it impossible to draw conclusions about the effectiveness of acupuncture as a treatment for psychological symptoms associated with opioid addiction. Other limitations that hindered the comprehensiveness of most existing studies include insufficient reporting of adverse events, practitioners’ background, or response of patients. Commonly reported adverse events associated with acupuncture included needle pain (1-45%), tiredness (2-41%), and bleeding (0.03-38%); fainting and syncope were common (86%).49 Practitioners’ background is important as it helps to ensure accurate representation of a clinical setting in the studies. Physician experience suggests that better therapeutic acupuncture effects are obtained by doctors with several years, or even decades, of clinical training.50 Traditionally, the evocation of deqi response (得气療效) is often sought from patients but is not always reported in the studies. Deqi, the sensation of numbness and fullness at the site of stimulation, is believed to be important for acupuncture analgesia.51,52 Scientific evidence showed that deqi was predictive of a positive outcome in osteoarthritis,53 and significant correlations were found of analgesia with numbness and soreness rating,54 suggesting that attributes of deqi sensation could be useful indicators of effective treatment.

There is evidence of no significant effect of acupuncture on opioid withdrawal–associated psychological 55-57 symptoms. All of these studies used auricular acupuncture instead of conventional body acupuncture. The original protocol of Wen and Cheung16 employed 4 body acupoints in addition to 2 ear points. It is certainly worth investigating the synergistic effects of a different combination of acupoints. Further studies of the presence and absence of needle manipulation, and type of stimulation would help practitioners to design appropriate and balanced treatment for opioid withdrawal symptoms.

Sleep Disturbance

Another significant symptom in opioid withdrawal is sleep disturbance, positively correlated with relapse to heroin abuse. Clinically, individuals who are more deprived of sleep drop out of treatment earlier.58 Transcutaneous electrical acupoint stimulation has been shown to exert an immediate hypnotic effect in a third of heroin addicts.59 Animal studies showed that during acute morphine withdrawal, rapid eye movement (REM) sleep, non–rapid eye movement (NREM) sleep, and total sleep time decreased, while sleep latency was prolonged. On the contrary, both 100-Hz EA and 2-Hz EA significantly increased REM sleep, NERM sleep, and total sleep time.60 These studies may aid in the design of treatment that improves sleep profile and thus reduces risk of relapse. Chong et al61 compared opioid-associated sleep-related symptoms in 60 individuals. The experimental group was needled at bilateral Neiguan, Shenmen, Zusanli, Sanyinjiao, Jiaji T5-7 and Shenshu, and electrostimulation was applied on Zusanli, Sanyinjiao, Jiaji T7, and Shenshu with continuous wave (3-5 Hz) for 20 minutes, 5 times a week for a total of 15 times. The control group received no treatment. Sleeping difficulties, such as difficulty falling asleep and easy awakening, could be alleviated by acupuncture with the above protocol (p < 0.01). Zhu et al62 utilised the same acupuncture points as Chong et al61 but employed sparse wave EA (10 Hz, 5 mA) for 20 minutes, 3 times a week for 10 weeks. They performed acupuncture at points on the back before moving on to acupoints on the limbs, and observed lowered scores for sleep-related symptoms (p < 0.001).

Effect on Acupuncture on Craving

Craving is another important trigger of heroin relapse. Acupuncture was shown to suppress morphine self- administration in animals.63 Lee et al64,65 demonstrated that acupuncture at Yanggu (阳谷; SI-5) reduced morphine- seeking (craving) behaviour following abstinence after both a fixed ratio (FR) schedule and progressive ratio (PR) schedule, with c-Fos expression in both VTA and NAc suppressed.66 Shenmen (HT-7) was also tested and showed attenuation of morphine self-administration at both low dose (0.1 mg/kg)67 and high dose68 on a FR schedule. The active lever press decrease for FR schedule and breakpoint suppression for PR schedule were reversed by pretreatment with the selective GABAA antagonist bicuculline or the selective GABAB antagonist SCH50911, suggesting acupuncture on SI-5–mediated morphine craving through the GABAergic pathway.

Researchers also studied EA on other acupoints. Zusanli (ST-36) and Sanyinjiao (SP-6) were shown to significantly reduce cue-induced reinstatement of heroin seeking in rats, with attenuation of FosB expression in the NAc core,69 and other regions including anterior and posterior cingulate cortex, central nucleus of amygdala, NAc shell, VTA, and locus coeruleus.70,71

It is known that environmental cues can activate specific brain regions in heroin addicts, and functional magnetic resonance imaging (fMRI) can reveal these craving-related brain regions.72 Cai et al73 examined the influence of acupuncture on cue-elicited brain activation in heroin addicts. Comparisons were made between addicts and controls presented with heroin cue exposure, heroin cue exposure plus acupuncture at Zusanli, with or without needle twirling. Heroin cues elicited significant activation of craving-related brain regions, mainly in the frontal lobes and callosal gyri. In the heroin addict group, acupuncture without needle twirling did not significantly affect the range of cue-induced brain activation, but it significantly changed the extent of activation. Acupuncture with needle twirling, on the contrary, significantly decreased both the range and extent of activation during heroin cue exposure, when compared with the group without needle twirling. Unfortunately, the experiment was limited by small sample size, lack of non-addict control subjects, and the 2-dimensional images often provided by brain fMRI. Nonetheless, since Zusanli can rapidly suppress activation of craving-related brain regions, more studies should investigate its potential as an intervention for opioid craving.

Mu et al74 evaluated craving clinically and performed a follow-up study to examine relapse rate. They compared the effects of acupuncture on bilateral Neiguan, Shenmen, Zusanli, Sanyinjiao (Group 1) and that on bilateral Jiaji T5-7 and Shenshu (Group 2). Needles were applied on these acupoints, whereas electrostimulation was done in the selected acupoints: Zusanli and Sanyinjiao (Group 1), Jiaji T7 and Shenshu (Group 2) with sparse wave on 5 Hz, 5 mA for 20 minutes, 3 times a week for 10 weeks; a sham group had electrodes fixed on Zusanli and Sanyinjiao without actual stimulation, and a control group received no treatment. Craving recall (as measured by visual analogue scale) was lower in both acupuncture groups compared with the sham and control groups (p < 0.01). Serum β-endorphin and dynorphin-A levels were also higher in the 2 acupuncture groups (p < 0.01). Comparison of the 2 experimental groups revealed that EA on bilateral Jiaji T5-7 and Shenshu seemed to alleviate heroin protracted withdrawal to a greater extent than bilateral Neiguan, Shenmen, Zusanli, and Sanyinjiao (p < 0.01). All groups were followed up 6 months after discharge. Of 120 cases, 98 were successfully contacted. The relapse rate in the Jiaji T5-7 and Shenshu group was 77.3%; that of Neiguan, Shenmen, Zusanli, Sanyinjiao group was 88.5%, whereas that of sham group was 90.5% and controls being 95.7%. The relapse rate of the Jiaji T5-7 and Shenshu group was significantly lower than the Neiguan, Shenmen, Zusanli, Sanyinjiao group, as well as the sham and control groups (p < 0.05). It is known that the usual relapse rate within 6 months of detoxification is > 95%,75 with protracted withdrawal symptoms a prominent factor in relapse.76

Regardless of the supporting evidence for the potential of acupuncture as an intervention for craving, existing meta-analysis showed no significant benefit of acupuncture.39 More high-quality clinical trials are needed to determine whether and how acupuncture influences craving and relapse in human addicts.

Properties of Acupoints

As shown in the systematic review by Zhang et al39 the acupoint Neiguan (PC-6) is the most frequently used point for management of psychological symptoms in heroin addiction treatment, followed by Zusanli, Sanyinjiao, Shenmen, and Hegu (合谷; LI-4).39 These acupoints were also the most commonly used points in a systematic review by Lin et al.50 Neiguan is located 3 finger breadths below the wrist on the inner forearm in between the 2 tendons. It is the Luo- connecting point of the Pericardium channel that links to its exterior-interior Heart channel. From the Chinese medicine perspective, the pericardium is an organ system known to help defend the heart against pathogens and illnesses. The heart system is related to not only cardiovascular illnesses but also psychological problems. Thus, acupuncture on Neiguan can theoretically help alleviate the psychological attributes of protracted withdrawal such as anxiety and depression. Studies have shown that involvement of Neiguan helped augmented treatment of depression and anxiety.77,78 Furthermore, Neiguan has branches that reach the Triple energiser meridian. It targets Qi depression (气机壅滯) or sputum accumulation and thus can also treat other protracted withdrawal symptoms such as abdominal distension, anorexia, belching, vomiting, and tightness of the chest. Neiguan is best known in the West for treating nausea and vomiting. Acupressure on Neiguan has been shown to improve gastro-intestinal motility in women following transabdominal hysterectomy.79

Zusanli is the He-sea point (合穴) of the Stomach channel in the Five-shu points (五输穴). It is known for treating symptoms of the digestive system and for its pain- relieving effect.80 Sanyinjiao is the Yuan-primary point (原 穴) of the Spleen channel, as well as the crossing point of the 3 channels namely Liver, Spleen, and Kidney; it serves the body by nourishing Liver-yin (肝陰), Spleen-yin (脾陰) and Kidney-yin (腎陰), respectively. Shenmen is the Yuan- primary point of the Heart channel, and is reported to treat insomnia81 and anxiety.82 Hegu is the Yuan-primary point of the Large Intestine channel. It is an important acupoint in acupuncture anaesthesia.

Acupuncture as Adjuvant Treatment

In addition to the promising yet inconclusive findings about the efficacy of acupuncture in the treatment of opioid addiction, researchers have also studied acupuncture as an adjuvant treatment. Instead of replacing allopathic medications during opioid detoxification, studies examined whether acupuncture could augment treatment efficacy in its ancillary role. Some studies reported significant decrease in the dose requirement of buprenorphine or methadone to alleviate opioid withdrawal symptoms,83,84 others suggested that combined treatment may result in a lower relapse rate.85-87 A meta-analysis by Liu et al88 revealed that patients who received acupuncture combined with opioid agonist treatment scored lower for opioid withdrawal symptoms than individuals who received opioid agonist treatment only, on the first day and last 3 days of a 10-day tapered dose. There was no significant difference between the 2 groups in relapse rate at 6 months. The existing evidence suggests that acupuncture as an adjuvant treatment may have the potential to decrease dosage of agonist needed and alleviate the agonist’s side-effect. Nonetheless, stronger evidence and more high-quality research are needed to allow firm conclusions to be drawn.


Early studies concluded that electrical stimulation at a low frequency (2 Hz) accelerates endorphin and encephalin production, whereas high-frequency stimulation (100 Hz) up-regulates dynorphin level. Later evidence suggested that 100-Hz EA is effective in reducing withdrawal symptoms, with a suggestion that dynorphin suppresses withdrawal at the spinal level. The effect of 100-Hz EA may be associated with BDNF activation at the VTA, while a cumulative effect of multiple 100-Hz stimulation may be related to acceleration of dynorphin synthesis and down-regulation of p-CREB.

Meta-analysis of clinical trials indicated the potential of acupuncture as a treatment for opioid-associated depression and anxiety, but no statistically significant beneficial effect was reported for opioid craving. Most studies are limited by small sample size, insufficient reporting of methodology, and variations in treatment regimens. Analysis is thus inconclusive. Despite this, animal studies demonstrated an influence of acupuncture on withdrawal symptoms. In the treatment of sleep disturbance, EA at both 100 Hz and 2 Hz significantly increased REM sleep, NERM sleep, and total sleep time. For craving, drug-seeking behaviour was suppressed by acupuncture and was reversed by pretreatment with selective GABA antagonists, suggesting mediation of morphine craving through the GABAergic pathway. Acupuncture demonstrated considerable potential as an adjuvant treatment, but analysis provided no evidence of it being otherwise superior to pharmacological treatment alone. Regardless of the inconsistencies in therapeutic effect, key acupoints for opioid addiction have been identified. Considering the potential demonstrated by animal studies, further high-quality studies that investigate the synergistic effects of a combination of acupoints may enable treatment to be refined.


  1. Central Registry of Drug Abuse drug statistics. Narcotics Division, Security Bureau, Hong Kong SAR Government; 2015.
  2. Darke S, Ross J, Hall W. Overdose among heroin users in Sydney, Australia: I. Prevalence and correlates of non-fatal overdose. Addiction 1996;91:405-11.
  3. Davoli M, Perucci CA, Rapiti E, Bargagli AM, D’Ippoliti D, Forastiere F, et al. A persistent rise in mortality among injection drug users in Rome, 1980 through 1992. Am J Public Health 1997;87:851-3.
  4. Hagan H, Thiede H, Weiss NS, Hopkins SG, Duchin JS, Alexander ER. Sharing of drug preparation equipment as a risk factor for hepatitis C. Am J Public Health 2001;91:42-6.
  5. Cumberlidge MC. The abuse of barbiturates by heroin addicts. Can Med Assoc J 1968;98:1045-9.
  6. Fanciullo GJ. Chapter 227: Pharmacologic (analgesic) treatment of pain. In: Samuels MA, Feske SK, editors. Office practice of neurology. 2nd ed. Philadelphia: Churchill Livingstone; 2003:1438-44.
  7. Department of Health. Task force to review services for drug misusers: report of an independent review of drug treatment services in England. London: HMSO; 1996.
  8. Department of Health. Drug misuse and dependence: guidelines on clinical management. London: HMSO; 1999.
  9. Dole VP, Nyswander ME, Kreek MJ. Narcotic blockade. 1966. J Psychoactive Drugs 1991;23:232.
  10. Dewey W. Buprenorphine. In: Enna SJ, Bylund DB, editors. xPharm: The comprehensive pharmacology reference. New York: Elsevier; 2007:1-6.
  11. 1 Bernstein E, Bernstein JA, Weiner SG, D’Onofrio G. Substance use disorders. In: Tintinalli JE, Stapczynski JS, Ma OJ, Yealy DM, Meckler GD, Cline DM, editors. Tintinalli’s emergency medicine: a comprehensive study guide. 8th ed. New York: McGraw-Hill; 2016:292.
  12. Mahajan G, Holtsman M. Chapter 11: Major opioids in pain management. In: Benzon HT, Raja SN, Liu SS, Fishman SM, Cohen >SP, editors. Essentials of pain medicine, third edition. Saint Louis: W.B. Saunders; 2011:85-96.
  13. Hopper JA. Chapter 234: Opioids. In: McKean SC, Ross JJ, Dressler DD, Brotman DJ, Ginsberg JS, editors. Principles and practice of hospital medicine. New York: McGraw-Hill; 2012:1954-60.
  14. Wen HL, Teo SW. Experience in the treatment of drug addiction by electro-acupuncture. Xianggang Hu Li Za Zhi 1975;19:33-5.
  15. Wen HL. Fast detoxification of heroin addicts by acupuncture and electrical stimulation (AES) in combination with naloxone. Comp Med East West 1977;5:257-63.
  16. Wen H, Cheung S. Treatment of drug addiction by acupuncture and electrical stimulation. Asian J Med 1973;9:138-41.
  17. Smith MO. Acupuncture and natural healing in drug detoxification. Am J Acupunct 1979;7:97-107.
  18. Margolin A. Acupuncture for substance abuse. Curr Psychiatry Rep 2003;5:333-9.
  19. Han JS, Chen XH, Sun SL, Xu XJ, Yuan Y, Yan SC, et al. Effect of low- and high-frequency TENS on Met-enkephalin-Arg-Phe and dynorphin A immunoreactivity in human lumbar CSF. Pain 1991;47:295-8.
  20. Han JS, Wang Q. Mobilization of specific neuropeptides by peripheral stimulation of identified frequencies. News Physiol Sci 1992;7:176- 80.
  21. Han JS, Zhang RL. Suppression of morphine abstinence syndrome by body electroacupuncture of different frequencies in rats. Drug Alcohol Depend 1993;31:169-75.
  22. Wu LZ, Cui CL, Han JS. Treatment of heroin addicts by 4-channel Han’s Acupoint Nerve Stimulator (HANS). J Beijing Med Univ 1999;31:239-42.
  23. Wen HL, Ho WK. Suppression of withdrawal symptoms by dynorphin in heroin addicts. Eur J Pharmacol 1982;82:183-6.
  24. Green PG, Lee NM. Dynorphin A-(1-13) attenuates withdrawal in morphine-dependent rats: effect of route of administration. Eur J Pharmacol 1988;145:267-72.
  25. Cui CL, Wu LZ, Han JS. Spinal kappa-opioid system plays an important role in suppressing morphine withdrawal syndrome in the rat. Neurosci Lett 2000;295:45-8.
  26. Hooke LP, He L, Lee NM. Dynorphin A modulates acute and chronic opioid effects. J Pharmacol Exp Ther 1995;273:292-7.
  27. Cui CL, Wu LZ, Luo F. Acupuncture for the treatment of drug addiction. Neurochem Res 2008;33:2013-22.
  28. Takemori AE, Loh HH, Lee NM. Suppression by dynorphin A-(1-13) of the expression of opiate withdrawal and tolerance in mice. Eur J Pharmacol 1992;221:223-6.
  29. Wang GB, Wu LZ, Yu P, Li YJ, Ping XJ, Cui CL. Multiple 100 Hz electroacupuncture treatments produced cumulative effect on the suppression of morphine withdrawal syndrome: Central preprodynorphin mRNA and p-CREB implicated. Peptides 2011;32:713-21.
  30. Sklair-Tavron L, Shi WX, Lane SB, Harris HW, Bunney BS, Nestler EJ. Chronic morphine induces visible changes in the morphology of mesolimbic dopamine neurons. Proc Natl Acad Sci U S A 1996;93:11202-7.
  31. Robinson TE, Kolb B. Morphine alters the structure of neurons in the nucleus accumbens and neocortex of rats. Synapse 1999;33:160-2.
  32. Nestler EJ. Historical review: Molecular and cellular mechanisms of opiate and cocaine addiction. Trends Pharmacol Sci 2004;25:210-8.
  33. Chu NN, Zuo YF, Meng L, Lee DY, Han JS, Cui CL. Peripheral electrical stimulation reversed the cell size reduction and increased BDNF level in the ventral tegmental area in chronic morphine-treated rats. Brain Res 2007;1182:90-8.
  34. Chu NN, Xia W, Yu P, Hu L, Zhang R, Cui CL. Chronic morphine- induced neuronal morphological changes in the ventral tegmental area in rats are reversed by electroacupuncture treatment. Addict Biol 2008;13:47-51.
  35. Hu L, Chu NN, Sun LL, Zhang R, Han JS, Cui CL. Electroacupuncture treatment reverses morphine-induced physiological changes in dopaminergic neurons within the ventral tegmental area. Addict Biol 2009;14:431-7.
  36. Llorente del Pozo JM, Fernández Gómez C, Gutiérrez Fraile M, Vielva Pérez I. Psychological and behavioural factors associated with relapse among heroin abusers treated in therapeutic communities. Addict Behav 1988;23:155-69.
  37. Kaplan HB, Meyerowitz JH. Social and psychological correlates of drug abuse. A comparison of addict and non-addict populations from the perspective of self-theory. Soc Sci Med 1970;4:203-25.
  38. Merikangas KR, Kalaydjian A. Magnitude and impact of comorbidity of mental disorders from epidemiologic surveys. Curr Opin Psychiatry 2007;20:353-8.
  39. Zhang B, 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;2014:313549.
  40. Hou WG, Liang Y, Wang YX, Zong L, Chen YA. Clinical observation of electro-acupuncture intervention on depression of heroin addicts after withdrawal. Chin J Drug Abuse Prev Treat 2009;15:11-3.
  41. Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56-62.
  42. Mu JP, Liu L, Cheng JM, Zhou LZ, AO JB, Wang J, et al. Clinical study of electroacupuncture treatment for post-withdrawal anxiety and depression in drug addicts. Shanghai J Acupunct Moxibustion 2008;27(10):1-3.
  43. Zhang B, Luo F, Liu C. Treatment of 121 heroin addicts with Han’s acupoint nerve stimulator [in Chinese]. Zhongguo Zhong Xi Yi Jie He Za Zhi 2000;20:593-5.
  44. Rong J, Liu ZY, Asihae G. Clinical study on heroin withdrawal syndrome treated by scalp acupuncture in addicts. Chin J Drug Abuse Prev Treat 2006;12:205-8.
  45. Wen TQ, Yang ZJ, Lei XL, Xu SH, Huang Y, Du GS, et al. Clinical application of acupuncture for treatment of heroin withdrawal syndrome [in Chinese]. Zhongguo Zhen Jiu 2005;25:449-53.
  46. Song XG, Li XL, Wei KC, Xu DB, Li H, Shi FZ, et al. Influence of acupuncture on sleep disorders and anxiety in patients with heroin dependence. J Acupunct Tuina Sci 2012;10:150-4.
  47. 楊良、陳娟、徐習、徐儲綾、嚴婷、自钢等. 穴位电針配合中 药 治 療 阿 片 类 毒 品 成 癮 戒 斷 綜 合 征 療 效 觀 察 . 針 灸 臨 床 雜 志 2011;(08):7-9.
  48. Zeng X, Lei L, Lu Y, Wang Z. Treatment of heroinism with acupuncture at points of the Du Channel. J Tradit Chin Med 2005;25:166-70.
  49. Ernst E, White AR. Prospective studies of the safety of acupuncture: a systematic review. Am J Med 2001;110:481-5.
  50. Lin JG, Chan YY, Chen YH. Acupuncture for the treatment of opiate addiction. Evid Based Complement Alternat Med 2012;2012:739045.
  51. Chapter 14, section II/3: Manipulations and arrival of Qi (needling reaction). In: Cheung XN, editor. Chinese acupuncture and moxibustion. Beijing: Foreign Language Press; 1987:325-7.
  52. Stux G. Technique of acupuncture. In: Stux G, Pomeranz B, editors. Basics of acupuncture. Berlin: Springer-Verlag; 1997:202-13.
  53. Takeda W, Wessel J. Acupuncture for the treatment of pain of osteoarthritic knees. Arthritis Care Res 1994;7:118-22.
  54. Kong J, Fufa DT, Gerber AJ, Rosman IS, Vangel MG, Gracely RH, et al. Psychophysical outcomes from a randomized pilot study of manual, electro, and sham acupuncture treatment on experimentally induced thermal pain. J Pain 2005;6:55-64.
  55. Lua PL, Talib NS. Auricular acupuncture for drug dependence: an open-label randomized investigation on clinical outcomes, health- related quality of life, and patient acceptability. Altern Ther Health Med 2013;19:28-42.
  56. Bearn J, Swami A, Stewart D, Atnas C, Giotto L, Gossop M. Auricular acupuncture as an adjunct to opiate detoxification treatment: effects on withdrawal symptoms. J Subst Abuse Treat 2009;36:345-9.
  57. Avants SK, Margolin A, Holford TR, Kosten TR. A randomized controlled trial of auricular acupuncture for cocaine dependence. Arch Intern Med 2000;160:2305-12.
  58. Beswick T, Best D, Rees S, Bearn J, Gossop M, Strang J. Major disruptions of sleep during treatment of the opiate withdrawal syndrome: differences between methadone and lofexidine detoxification treatments. Addict Biol 2003;8:49-57.
  59. Wu LZ, Cui CL, Han JS. Han’s acupoint nerve stimulator for the treatment of opiate withdrawal syndrome. Chin J Pain Med 1995;1:30- 8.
  60. Li YJ, Zhong F, Yu P, Han JS, Cui CL, Wu LZ. Electroacupuncture treatment normalized sleep disturbance in morphine withdrawal rats. Evid Based Complement Alternat Med 2011;2011:361054.
  61. 宗蕾、侯文光、王晓曉、安伯維. 針刺治療海洛因依賴者稽延期 睡眠障碍療效觀察. 上海針灸雜志2009;(4):191-4.
  62. 朱忠春、穆敬平、梁艷、宗蕾、胡軍、徐平. 电針治療海洛因依 賴者戒斷后睡眠障碍的臨床觀察. 上海針灸雜志2005;(5):6-8.
  63. Yoon SS, Kim H, Choi KH, Lee BH, Lee YK, Lim SC, et al. Acupuncture suppresses morphine self-administration through the GABA receptors. Brain Res Bull 2010;81:625-30.
  64. Lee BH, Ma JH, In S, Kim HY, Yoon SS, Jang EY, et al. Acupuncture at SI5 attenuates morphine seeking behavior after extinction. Neurosci Lett 2012;529:23-7.
  65. Lee BH, Lim SC, Jeon HJ, Kim JS, Lee YK, Lee HJ, et al. Acupuncture suppresses reinstatement of morphine-seeking behavior induced by a complex cue in rats. Neurosci Lett 2013;548:126-31.
  66. Lee BH, Zhao RJ, Lee BG, Kim NJ, Yang CH, Kim HY, et al. Acupuncture suppresses morphine craving in progressive ratio through the GABA system. J Acupunct Meridian Stud 2015;8:175-82.
  67. Suto N, Wise RA, Vezina P. Dorsal as well as ventral striatal lesions affect levels of intravenous cocaine and morphine self-administration in rats. Neurosci Lett 2011;493:29-32.
  68. Lee BH, Ku JY, Zhao RJ, Kim HY, Yang CH, Gwak YS, et al. Acupuncture at HT7 suppresses morphine self-administration at high dose through GABA system. Neurosci Lett 2014;576:34-9.
  69. Hu A, Lai M, Wei J, Wang L, Mao H, Zhou W, Liu S. The effect of electroacupuncture on extinction responding of heroin-seeking behavior and FosB expression in the nucleus accumbens core. Neuroscience Letters 2013;534:252-7.
  70. 孫丽敏、甄利波、劉宜軍、劉惠芬、張富强、楊国棟等. 低頻电 針對海洛因覓药行為及相關腦區FosB蛋白表达的影响. 中国針灸 2006;(11):833-7.
  71. 王育紅、甑利波、劉义軍、郝偉、張富强、周文华等. 电針對海 洛因引燃誘導大鼠覓药行為及相關腦區FosB表达的影响. 中南大学学報(医学版) 2008;(4):299-304.
  72. Garavan H, Pankiewicz J, Bloom A, Cho JK, Sperry L, Ross TJ, et al. Cue-induced cocaine craving: neuroanatomical specificity for drug users and drug stimuli. Am J Psychiatry 2000;157:1789-98.
  73. Cai X, Song X, Li C, Xu C, Li X, Lu Q. Acupuncture inhibits cue- induced heroin craving and brain activation. Neural Regen Res 2012;7:2607-16.
  74. 穆敬平、劉莉、方偉、程建明、趙磊. 电針夾脊穴對海洛因依賴 者心理渴求及血漿β-EP、Dyn-A影响. 中国針灸2010;(11):881-5.
  75. 王小铁、秦伯益. 納曲酮防止阿片类依賴病人戒毒后复吸的研究 現狀. 中国药物依賴性通報1995;(3):139-45.
  76. Jaffe JH. Drug dependence. In: Kaplan HI, Sadock BJ, editors. Comprehensive textbook of psychiatry. 4th ed. Baltimore: Williams & Wilkins; 1985:991.
  77. He LL, Zheng Z, Cai DJ, Zou K. Randomized controlled trial on comorbid anxiety and depression treated with electroacupuncture combined with rTMS [in Chinese]. Zhongguo Zhen Jiu 2011;31:294-8.
  78. Sun H, Zhao H, Ma C, Bao F, Zhang J, Wang DH, et al. Effects of electroacupuncture on depression and the production of glial cell line– derived neurotrophic factor compared with fluoxetine: a randomized controlled pilot study. J Altern Complement Med 2013;19:733-9.
  79. Chen LL, Hsu SF, Wang MH, Chen CL, Lin YD, Lai JS. Use of acupressure to improve gastrointestinal motility in women after trans- abdominal hysterectomy. Am J Chin Med 2003;31:781-90.
  80. 王賀春、万有、王韵、韓济生. 不同穴位电針治療大鼠慢性神经 源性痛的療效比較. 針刺研究2002;(3):180-5.
  81. 王全仁、王朝社、齐翠蘭、晋梅、王小玲. 針灸三陰交治療失眠 168例臨床觀察. 中国針灸1995;(4):29-30.
  82. 喬岩岩. 神門透刺少海治療焦慮症狀30例. 中国針灸2001;21:81- 2.
  83. Wu LZ, Cui CL, Han JS. Treatment of heroin addicts by 4-channel Han’s Acupoint Nerve Stimulator (HANS). J Beijing Med Univ 1999;31:239-42.
  84. Wu LZ, Cui CL, Han JS. Reduction of methadone dosage and relief of depression and anxiety by 2/100 Hz TENS for heroin detoxification. Chin J Drug Depend 2001;10:124-6.
  85. Wang ZT, Yuan YQ, Wang J, Luo JK. Observations on the efficacy of electro-acupuncture therapy plus medicine for treating heroin addiction. Chin J Inform Tradit Chin Med 1999a;6:35.
  86. Wang ZT, Yuan YQ, Wang J, Luo JK. Observations on the efficacy of electro-acupuncture therapy plus medicine for treating heroin addiction. Zhongguo Zhen Jiu 1999b;18:657-8.
  87. Wang ZT, Yuan YQ, Wang J, Luo JK. Observations on the efficacy of auricular-plaster therapy plus medicine for treating heroin addiction. Shanghai Zhen Jiu Za Zhi 2005;24:6-7.
  88. 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;29:449-54.
View My Stats
idm full crack IDM Crack Internet Download Manager Crack KMSAuto++ Windows 11 Activator Crack IDM IDM Crack 6.41 CryptoCurrency News Download Crack