Abstract
Opioid Use Disorder (OUD) is an impactful condition with only moderately effective treatments available and relapse especially common early in treatment. This project determined the feasibility of delivering an accelerated course of repetitive transcranial magnetic stimulation (rTMS) to participants with OUD during medically managed withdrawal. If feasible, delivering rTMS at this early stage of treatment may improve outcomes. Participants included those with moderate or severe OUD who were undergoing medically-managed withdrawal using either buprenorphine or methadone. During the taper, eighteen-sessions of rTMS were applied over three days (6-sessions/day separated by 30-minutes, 10Hz, figure-of-eight-coil, EEG coordinate F3, 3000 pulses each, 120% rMT, delivered during opioid image presentation). The first participant underwent open-label study-treatment, while the final six were treated in a double-blind sham-controlled fashion. The primary outcome measures included provoked craving following a standardized cue paradigm, as well as subjective pain measures. Four participants received active stimulation, three of which (27F, 27M, 31F) completed treatment at 120%rMT, and one (27M) withdrew due to symptoms of opioid withdrawal. Three participants received sham stimulation (30F, 27M, 51M) two of which completed treatment at 120%rMT and one other completing treatment at 100% rMT. The blind was effective and only one headache occurred as an adverse event. No statistics were run due to the small sample size, however the participants who received active stimulation reported that composite craving (want, resist, crave opioids) dropped numerically more in the active-group (mean decrease 10.3±8.1) then in the sham-group (mean decrease 7.0±4.6) following a standard opioid cue paradigm. Clinical pain was low at baseline and changed minimally following the intervention. No firm conclusions can be drawn from this pilot trial, which was stopped early due to the COVID19 pandemic, however accelerated treatment with rTMS appears to be well tolerated by those undergoing medically managed withdrawal. Keywords: opioid, craving, clinical trial, rTMS
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