b'buprenorphine versus the standard of care sublin-gual formulation, administered as part of routineThe authors explained that outpatient care to 952 veterans across 20 sites indevice effects appear to the VHA. Unfortunately,beforethetrialwasinitiated,thebe related to reduction worldwide pandemic occurred, and the authors hadof autonomic symptoms to determine how to proceed while protecting par-ticipant and staff safety. The study was recruitingassociated with withdrawal early this year. from opioids including Auricular Stimulators sweating, gastrointestinal New guidelines from the VA and DoD do not in- upset, agitation, insomnia cludeinformationonnoninvasiveelectricalnerve stimulators, which have been approved by the Foodand joint pain.and Drug Administration for the adjunct treatment ofopioidwithdrawalsymptoms.Thedevicesare placedbehindtheeartostimulatecertaincranial nerves with auricular projections and to relieve somesweating, gastrointestinal upset, agitation, insomnia of the difficult withdrawal symptoms faced by SUDand joint pain. Researchers said past studies have patients. shown that the vagus and glossopharyngeal nerves In2020,aftertwoofthosehadreceivedFDAcan play a role in mediating the response or that acti-approval,anarticleinBioelectronicMedicine,vation of the parasympathetic nervous system can noted, The recent opioid crisis is one of the risinghave that effect.challenges in the history of modern health care. NewUseofsuchdevicescanultimatelyreducethe and effective treatment modalities with less adverseneedofsupportivemedicationsandcanfacilitate effects to alleviate and manage this modern epidemicsmooth transition from detoxification to commenc-are critically needed, adding, Current experimen- ing medication-assisted treatment in opioid depen-tal evidence indicates that this type of noninvasivedentpatients.Thistreatmentmodalityhassofar neural stimulation has excellent potential to supple- been associated with only minor local side effects ment medication-assisted treatment in opioid detoxi- at the device placement site. While this noninvasive fication with lower side effects and increased adher- modality appears to be an exciting new opportunity ence to treatment. 3 in alleviating the current opioid epidemic, more stud-Northwell Health-led researchers advised that bio- ies are clearly needed to further validate the poten-electronic medicine is an emerging field focusing ontial of this intervention and support its use with the the use of neuromodulation to provide alternative,hope of helping our patients and their families, the nonpharmacologicaltreatmentsforvariousdis- authors concluded.eases. The therapeutic approaches based on vagus1De Aquino JP, Parida S, Sofuoglu M. The Pharmacology of Buprenor-nerve stimulation have already generated promisingphine Microinduction for Opioid Use Disorder. Clin Drug Investig. results in several chronic disorders, including rheu- 2021 May;41(5):425-436. doi: 10.1007/s40261-021-01032-7. Epub matoidarthritisandinflammatoryboweldisease,2021 Apr 5. PMID: 33818748; PMCID: PMC8020374.they noted, adding, The therapeutic utility of nonin- 2Petrakis, I., Springer, S.A., Davis, C. et al. Rationale, design and vasive approaches, including auricular vagus nervemethods of VA-BRAVE: a randomized comparative effectiveness trial of two formulations of buprenorphine for treatment of opioid use stimulation, is also currently being explored. disorder in veterans. Addict Sci Clin Pract 17, 6 (2022). https://doi.With use of the devices, electrical pulses are gen- org/10.1186/s13722-022-00286-6 erated and delivered to the ear via electrodes. The3Qureshi, I.S., Datta-Chaudhuri, T., Tracey, K.J. et al. Auricular neural authors explained that device effects appear to bestimulation as a new noninvasive treatment for opioid detoxification. related to reduction of autonomic symptoms asso- Bioelectron Med 6, 7 (2020). https://doi.org/10.1186/s42234-020-ciatedwithwithdrawalfromopioidsincluding00044-615'