Should cocaine-abusing, buprenorphine-maintained patients receive auricular acupuncture? Findings from an acute effects study.

OBJECTIVE Buprenophrine is a synthetic opioid with micro-agonist properties currently pending Food and Drug Administration (FDA) approval as a maintenance agent for treating heroin-addicted individuals. Unlike methadone, a widely used opioid maintenance agent, buprenorphine is a kappa-receptor antagonist. Research linking the effects of acupuncture to the release of dynorphin, the endogenous ligand for the kappa-receptor, raised the possibility that buprenorphine may block acupuncture's effects. In this study, we sought to gather preliminary data on this issue in order to guide the clinical care of cocaine-abusing, buprenorphine-maintained patients. DESIGN Between-group analysis comparing buprenorphine- and methadone-maintained patients on ratings of acute effects after a single session of auricular acupuncture. SUBJECTS Thirty-four (34) cocaine-abusing, opioid-dependent patients, eighteen (18) maintained on buprenorphine, and sixteen (16) maintained on methadone. INTERVENTION A single, 40-minute session of auricular acupuncture; four needles were inserted in each auricle. OUTCOME MEASURES Acute effect ratings in four domains: pain, de qi sensations, relaxation effects, subjective experiences. RESULTS There were no significant differences in acute-effects ratings between the two groups. Patients in both groups reported positive effects. CONCLUSIONS These preliminary findings are consistent with the interpretation that buprenorphine does not block auricular acupuncture, supporting the provisional recommendation that cocaine-abusing patients maintained on buprenorphine should not be excluded from receiving auricular acupuncture or from participating in clinical studies of this treatment modality. Further, controlled research on this issue, with clinical outcomes, is needed.