Journal of Substance Abuse Treatment, Vol. 10, pp.

345-
3511993 Printe in t!e "SA. All ri#!ts reser$e.
0%40-54%&'93 ().00 * .00 +op,ri#!t - 1993 Per#amon Press .t.
A/T0+.1
Acupuncture 2eroin 3eto4ification5 A Sin#le-6lin +linical
Trial
All,son 7, 8as!burn, P!3,9 /obert 1. :ullilo$e, 13 7in,
T!ompson :ullilo$e, 73,t Patricia A. ;eenan, om( 6ett,
7c<ee, bs,( ;ennet! A. 7orris, mstcm,=
JA71S .. S>/1?S1?, P!3,9 A?3 8A@?1 8. +.A/;, P!3A
B"ni$ersit, of +alifornia, San :ranciscoC t+olumbia
"ni$ersit,, Sc!ool of Public 2ealt!C J6a,$ieD-2unterEs Point
:ounationC A+ommunit, Substance Abuse Ser$ices,
+it, an +ount, of San :rancisco 3epartment of Public 2ealt!
Abstract - T!e increasin# pre$alence of 20V infection amon#
inFection ru# users manates t!e e$elopment of inno$ati$e
treatments. 8!ile e4tensi$e clinical e4perience su##ests t!at
acupuncture eto4ification is bot! safe an acceptable to
t!ose in Dit!raDal, little researc! !as been conucte to
assess its efficac, as a treatment moalit,. 0n t!is first
controlle stu, of acupuncture !eroin eto4ification, 100
aicte persons Dere ranoml, assi#ne, in a sin#le-blin
esi#n, to t!e stanar auricular acupuncture treatment use
for aiction or to a Gs!amH treatment t!at use points t!at
Dere #eo#rap!icall, close to t!e stanar points. Attrition
Das !i#! for bot! #roups, but subFects assi#ne to t!e
stanar treatment attene t!e acupuncture clinic more a,s
an sta,e in treatment lon#er t!an t!ose assi#ne to t!e s!am
conition. Aitionall,, attenance $arie in$ersel, Dit!
self-reports of freIuenc, of ru# use, su##estin# t!at t!ose
Dit! li#!ter !abits foun t!e treatment moalit, more !elpful.
.imitations of t!e stu, are iscusse.
;e,Dors - acupuncture eto4ificationC !eroin eto4ification,
clinical trialC auricular acupunctureC ru# treatment.
2eroin aiction continues to be a maFor public !ealt!
problem. Traitional opioi eto4ification met!os inclue &1-
a, met!aone treatment, narcotic anta#onist Dit!raDal, an
t!e use of $arious meications to ameliorate t!e s,mptoms of
Dit!raDal.
+onucte uner +ontract ?umber 3-000&-J Dit! t!e +alifornia
3epartment of Alco!ol an 3ru# Pro#rams Dit! partial support
b, #rant number 1/1J3A0)09% from t!e ?ational 0nstitute on
3ru# Abuse an a +enters #rant K724&459 from t!e ?ational
0nstitute of 7ental 2ealt! an t!e ?ational 0nstitute on 3ru#
Abuse. T!e aut!ors especiall, t!anL S!irle, <ross, t!e
14ecuti$e 3irector of t!e 6a,$ieD-2unterEs Point :ounation,
an t!e treatment staff an clients at t!e :ounationEs
Substance Abuse Ser$ices. 0n aition, for t!eir assistance
Dit! ata collection an anal,sis, De acLnoDle#e ;e$in
3elucc!i, 1$e <olen, ?icL 3aniels, .a7ar 2asbroucL, Jocel,n
?aMareno, 7aira 6enFamin, an /on 2enerson.
/eIuests for reprints s!oul be aresse to All,son 7.
8as!burn, P!3, San :rancisco Treatment /esearc! "nit, San
:rancisco <eneral 2ospital, Substance Abuse Ser$ices8ar 93
1001 Potrero A$enue, San :rancisco, +A 94110.
7et!aone-supporte Dit!raDal, as a Diel, use treatment
moalit,, !as been e4tensi$el, stuie Ne.#., Sorensen,
2ar#rea$es, O 8einber#, 19J&C /aDson, 7ann, Tennant, O
+labou#!, 19J3C Tennant, 19J)P, but little is LnoDn about
alternati$e treatments. T!e increasin# pre$alence of 20V
infection amon# intra$enous ru# users N7iller, Turner, O
7oses, 1990Pas Dell as t!e !i#! personal an societal costs
of aiction, manates t!e e$elopment of inno$ati$e treatment
moalities.
Acupuncture is a nontraitional met!o of treatment t!at
merits controlle stu,. :or centuries, +!ina an ot!er
1astern countries !a$e use acupuncture to treat a $ariet, of
ailments NSteiner, 19J3P. 0n recent ,ears, practitioners of
+!inese meicine !a$e use acupuncture in t!e treatment of
substance abuse. A number of stuies N+lement-Jones,
7c.ou#!lin, .oDre,, 6esser, /ees, O 8en, 19%9C PertA.,
3ionne, ?#, 6ra#in, 7oo,, O Pert, +., 19J1C ;iser, ;!atami,
<atc!el, 2uan#, 6!atia, O Alts!uler, 19J3P !a$e linLe
345
34)
A.7. 8as!burn et al.
auricular acupuncture to increase prouction of eno#enous
opiate pepties suc! as beta-enorp!ins an enLep!alinsC t!is
is t!ou#!t b, some researc!ers Ne.#., +opolo$ O 2elme, 19J3P
to be t!e mec!anism of action of t!e treatmentEs purporte
effects on opiate Dit!raDal.
T!e ?ational Acupuncture 3eto4ification Association, Dit!
5%0 certificate members, estimates t!at t!ere are noD &00
acupuncture eto4ification pro#rams in t!e "nite States an
1urope N7. Smit!, personal communication, 7a, 141991P. :or
t!e past 1% ,ears, acupuncture eto4ification !as been t!e
primar, met!o of treatment at t!e .incoln 2ospital in ?eD
@orL. An a$era#e of &00 aicte persons are treate ail, in
t!is cit,-oDne !ospital. A recent paper reporte t!at 409b of
neD patients epenent on cracL cocaine #a$e clean urine tests
se$eral DeeLs after treatment NSmit! O ;!an, 19JJP. T!e
aut!ors relate t!at acupuncture eto4ification patients
e4perience #eneral rela4ation, relief of Dit!raDal s,mptoms
an cra$in#, an en!ancement of mental an p!,sical
functionin#.
8!ile clinical e4perience su##ests t!at acupuncture
eto4ification is bot! safe an acceptable to patients, little
researc! !as been conucte to assess its efficac, as a ru#
treatment moalit,. ?earl, all of t!e stuies reporte in t!e
literature !a$e emplo,e nonranomiMe, unbline esi#ns
N?eDme,er, Jo!nson, ;iot, O 7oon, 19J1C ;roeni# O >leson,
19J5C .eDen- ber#, 19J5P. 14ceptions inclue tDo stuies of
t!e use of acupuncture in treatin# se$ere recii$ist
alco!olics b, 6ullocL an !is collea#ues N6ullocL, "men,
+ulli- ton, O >laner, 19J%C 6ullocL, +ulliton, O >laner,
19J9P.
0n t!ese sin#le-blin stuies, 6ullocLEs #roup ranoml,
assi#ne alco!olics eit!er to treatment Dit! ear acupuncture
points specific to aiction or to treatment usin# Gs!amH ear
points. >utcomes Dere similar in bot! stuies Dit!
si#nificantl, more of t!e subFects recei$in# t!e stanar
acupuncture completin# all p!ases of treatment t!an t!ose
recei$in# s!am acupuncture. 0n t!e secon, lar#er stu, Nn Q
J0P, subFects recei$e acupuncture 5 times a DeeL for & DeeLsC
t!en, acupuncture 3 times a DeeL for 4 DeeLsC an, finall,,
acupuncture tDice a DeeL for & DeeLs. >f t!e 40 patients in
t!e treatment #roup, &1 N5&.3RP complete all p!ases of t!e
pro#ram compare to 1 N&.5SoP of t!e 40 controls. >nl, 3
N%.5S0P treatment patients left t!e pro#ram urin# p!ase
0D!ile 19 N4%.5RP of t!e control patients left treatment
urin# t!e first & DeeLs. 6ullocL et al. N19J9P foun, at t!e
)-mont! folloD-up, t!at ) of t!e &1 patients in t!e treatment
#roup D!o !a complete t!e pro#ram reporte t!at t!e, !a not
taLen an, alco!ol in t!e interim. 6, contrast, 39 control
patients an all treatment patients D!o !a faile to complete
t!e pro#ram reporte rinLin# episoes urin# t!e )-mont!
folloD-up perio.
T!e stu, reporte !ere is t!e first controlle in$es-
ti#ation of t!e use of acupuncture in !eroin eto4ification.
8e attempte to e4ten t!e DorL of 6ullocLEs #roup Dit!
alco!olics to t!e outpatient treatment of opioi epenent
persons. A sin#le-blin esi#n Das emplo,e to test D!et!er
t!e stanar acupuncture protocol for aiction Doul !a$e an
effect on treatment retention an on opiate use D!en compare
to a placebo, or Gs!am treatment.
71T2>3
T!is stu, Das conucte at t!e 6a,$ieD-2unters Point
:ounation, a non-profit !uman ser$ices a#enc, locate in a
primaril, African-American communit, in San :rancisco. T!e
:ounationEs substance abuse ser$ices inclue &1-a, met!aone
eto4ification, met!aone maintenance, an acupuncture
eto4ification. SubFects Dere 100 !eroin-aicte aults
resiin# in or near San :rancisco D!o met tDo selection
criteria5 T!e, reporte a !istor, of intra$enous use of !eroin
confirme b, p!,sical e4amination for si#ns of recent neele
use, an t!e, Dere not currentl, enrolle in a met!aone
eto4ification pro#ram. Prospecti$e stu, participants Dere
e4clue if t!e, Dere pre#nant or on parole or probation.
SubFects #a$e informe consent an pro$ie socioemo#rap!ic
ata an information concernin# ru# use an treatment !istor,
at intaLe into t!e &1-a, acupuncture trial. A &1-a,
treatment len#t! Das c!osen in orer to pro$ie outcome
results comparable to t!ose for e4istin# met!aone
eto4ification pro#rams.
3urin# treatment sta,, staff folloDe subFects ail, for
Dit!raDal si#ns an asLe for reports of ru# use. T!ere Dere
no penalties for ru#-positi$e reports. >n t!e first treatment
a, an DeeLl, t!ereafter, subFects complete a Dit!raDal
s,mptoms c!ecLlist an #a$e a urine sample. An off-site
laborator, conucte t!e urinal,ses, usin# t!in la,er
c!romato#rap!, to screen samples for t!e presence of 1) ru#
metabolites, incluin# t!ose for !eroin, met!aone, an
cocaine. +onfirmation tests Dere one on positi$e samplesC t!e
particular tests $arie accorin# to t!e ru#NsP foun.
SubFects recei$e (5.00 for eac! urine sample an (&0.00 for
time spent responin# to intaLe Iuestionnaires.
After intaLe, subFects Dere ranoml, assi#ne to one of tDo
treatment conitions, eit!er GstanarH or Gs!amH acupunctureC
t!e, Dere blin to conition. T!e stanar protocol use t!e
four ear points t!at Dere emplo,e in 6ullocLEs stuies
N6ullocL et al., 19J%C 19J9P5 s,mpat!etic, s!enmen, Line,,
an lun#. Points Dere Fu#e b, #eo#rap!ic location an b,
client- report of a tin#lin# or a !ot sensation D!en t!e tar-
#ete area Das touc!e Dit! a blunt instrument. T!e placebo,
or Gs!am conition use four ear points t!at are not t!ou#!t
to be specific for aiction. T!ese
Trial of Acupuncture 2eroin 3eto4ification
34%
S!am Stanar treatment treatment Nn Q 45P Nn Q 55P
%3R )3R
40.4 40.5
B$p Vp ?p ?.P TT .
& 4 % % 3 4 4 4 14 &
1
RRR.9RRRR&3RRRRRRR 9 & & 4 1 91J&U'& 0 9 9 9 & 9 3 1 1 3 4.&)
o
&
7ales 7ean a#e 1t!nicit, 8!ite
African-American American 0nian 7e4ican >t!er .atino 7ean
!i#!est #rae complete 1mplo,ment status :ull-time Part-time
"nemp. T SeeLin# DorL "nemp. T?ot seeLin# DorL 7ean a#e of
first use'abuse 3ru# use in past 30 a,s >nce
>nce'DeeL
&-3 times'DeeL
3-) times'DeeL >nce ail, &-3 times'a, V3 times'a,
7ean prior amissions to an, treatment pro#ram
?ote5 ?one of t!e ifferences betDeen t!e stanar an s!am
#roups Dere statisticall, si#nificant.
/1S".TS +lient +!aracteristics
>f t!e 100 stu, participants, 55 recei$e stanar
acupuncture an 45 t!e s!am treatment. T!e tDo treatment
#roups Dere compare on a $ariet, of emo#rap!ic an clinical
measures. As Table l s!oDs, no si#nificant ifferences Dere
etecte betDeen t!e #roups on an, of t!e $ariables e4amine.
T!e #roups Dere also compare on Dit!raDal si#ns an s,mptoms
at intaLe. >f subFects in t!e stanar #roup, %0.0R e$ience
si#ns of Dit!raDal an of t!ose in t!e s!am #roup, )).0RC
t!is ifference Das not statisticall, si#nificant. Scores on
t!e Dit!raDal s,mptoms instrument coul ran#e from 1% to J5C
t!e mean scores for t!e stanar #roup an for t!e s!am #roup
Dere not si#nificantl, ifferent, at 35.J an 31.9
respecti$el,.
Attenance PatternsC Treatment /etention
:i#ure 1 compares t!e percenta#e of subFects in t!e tDo
treatment conitions attenin# t!e acupuncture clinic b, a,
in t!e treatment course5 T!e number atten-
TA6.1 1
+!aracteristics of Participants in Acupuncture Trial
points, D!ic! are #eo#rap!icall, close to t!e stanar points,
Dere Fu#e b, lacL of tin#lin# or !ot sensation. Sin#le-use,
isposable neeles Dere use for t!e stu,. >nce neeles Dere
inserte, t!e, Dere left in place for &0-45 minutes. ?o manual
or electrical stimulation Das emplo,e. SubFects remo$e t!eir
oDn neeles an ispose of t!em in a container for !aMarous
Dastes.
Treatment Das aministere in a lar#e room t!at seate 40
people. SubFects recei$in# t!e tDo t,pes of acupuncture Dere
treate to#et!er an Dere asLe to sit Iuietl, t!rou#!out t!e
40-minute treatment. 0nteraction Dit! t!e acupuncturist Das
limite to t!e time reIuire for neele placement an
collection of si#ns an s,mptoms ata.
0n aition to acupuncture, all subFects recei$e support
ser$ices ientical to t!ose pro$ie to 6a,$ieD- 2unterWs
Point met!aone eto4ification clients. T!ese ser$ices
inclue an entrance p!,sical e4amination, counselin# an
isc!ar#e plannin#, an A03S eucation. SubFects Dere
permitte to continue treatment be,on t!e &1-a,
eto4ification perio Dit! t!e pro$iso t!at it be in t!e
conition to D!ic! t!e, Dere initiall, assi#ne.
3ata Dere anal,Me usin# SPSSX runnin# on an 067 3090
mainframe computer. Pearson c!i-sIuare tests an U-tests Dere
use, as appropriate, for comparisons of t!e socioemo#rap!ic,
ru# !istor,, an ru# use ata collecte at intaLe. T!e
treatment #roups Dere compare on tDo measures of attenance5
total number of a,s recei$e treatment an last a, in
treatment of t!e &1-a, perio. 6ecause t!e istributions for
bot! of t!ese $ariables Dere !i#!l, sLeDe, t!e 7ann-8!itne, "
test Das use for t!e anal,ses. T!e relations!ip betDeen total
a,s in treatment an len#t! of sta, Das e4amine usin# t!e
Pearson pro- uct-moment correlation.
T!e tDo #roups Dere compare on tDo aitional measures of
attenance5 percent attenin# t!e acupuncture clinic b, a, in
t!e treatment course an number of clients D!o sta,e in
treatment past &1 a,s. 3ata for t!e secon measure Dere
anal,Me usin# t!e c!i- sIuare test.
:inall,, tDo-Da, anal,ses of $ariance Dere conucte to
e$aluate t!e $ariation in mean number of a,s in treatment an
mean len#t! of sta, b, treatment conition an freIuenc, of
ru# use. :or t!e secon factor, self-reports of ru# use in
t!e 30 a,s prior to treatment entr, Dere stratifie into
t!ree le$els as folloDs5 li#!t use, efine as once ail, or
lessC meium use, tDo to t!ree times ail,C an !ea$, use,
more t!an t!ree times ail,. 6ecause bot! number of a,s in
treatment an last a, in treatment Dere !i#!l, sLeDe, t!e
natural lo#arit!ms of t!ese $alues Dere use for t!e anal,ses.
T!e folloDin# co$ariates Dere also e4amine5 a#e, #ener,
et!nicit,, a#e at first use, an s,mptom score on t!e first
a, of treatment.
RR 9 & & )
RRRRR.JR R R R S 1J 0 % 4 1 03)05' 35 1 1134.Y
1
34J
A.7. 8as!burn et al.
Percent
Attenin#
3a, in TraatnDnt
:0<"/1 1. Percent attenance b, treatment conition.
in# on a particular treatment a, of t!e &1-a, re#imen Das
i$ie b, t!e total number assi#ne to t!e #roup. Alt!ou#!
bot! #roups s!oD a s!arp initial rop in attenance, t!e s!am
treatment #roup s!oDe a #reater ecline. >n an, #i$en a, in
t!e treatment course, a lar#er proportion of clients recei$in#
stanar acupuncture attene t!e clinic t!an clients assi#ne
to t!e s!am conition.
Table & compares t!e tDo treatment #roups on t!ree
aitional measures of attenance5 meian number of a,s in
treatment, meian last a, Nof &1P, an number of subFects
sta,in# in treatment be,on &1 a,s. T!e table s!oDs t!at
subFects recei$in# t!e stanar acupuncture treatment attene
t!e clinic more a,s
TA6.1 &
.en#t!-of-Sta, for Acupuncture Trial Participants
S!am Stana
r
95R
treatm
ent
treatm
ent
confi
ence
Nn Q
45P
Nn Q
55P
inter$
al
7eian
number of
a,s
1 &9 Z a
7eian last
a, Nof &1P
1 &9 T
?umber
sta,in#
be,on
&1 a,s 4
N.09P
1)9
N.&9P
.0) .
34
a
+onfience inter$als cannot be compute for t!e meian $alues
compare b, t!e 7ann-8!itne, " test if t!e nWs are uneIual.
9p[ .05.
t!an subFects recei$in# t!e s!am treatmentC t!is effect Das
statisticall, si#nificant at'U [ .05. T!e mean number of a,s
in treatment Das &.1 for t!e s!am #roup an 4.& for t!e
stanar. T!e tDo #roups also iffere on t!e secon len#t!-
of-sta, measure reporte in t!e tableC t!e meian last a, in
treatment Das 1 for t!e s!am an & for t!e stanar subFects.
T!e mean last a, in treatment Nof &1P Das 3.J for t!e s!am
an ).) for t!e stanar subFects. ?ot surprisin#l,, t!ese tDo
attenance measures Dere !i#!l, correlate at r
4,
Q .J45 Np [ .
0001P. N8!en t!ose D!o !a roppe out of treatment after t!e
first a, Dere e4clue from t!e anal,sis, t!e correlation
coefficient Das nearl, as !i#! at r
4,
Q .%)3 Np [ .01P.P T!e
t!ir comparison betDeen t!e tDo #roups Das also si#nificantl,
ifferent Np [ .05P Dit! subFects recei$in# stanar
acupuncture more liLel, to continue treatment be,on t!e
initial &1 a,s t!an t!ose recei$in# t!e s!am acupuncture. >f
t!e subFects in t!e stanar #roup D!o returne after t!e
first treatment, 4).99o continue comin# to t!e clinic after
t!e &1-a, eto4ification perio.
Table 3 lists mean number of a,s in treatment b, conition
an self-reports of freIuenc, of !eroin use in t!e 30 a,s
precein# entr, into t!e stu,. A tDoDa, A?>VA of a,s in
treatment s!oDe main effects for bot! treatment conition
193P Q 10.09'%[ .01C an freIuenc, of use :N&
f
93P Q 5.&%p
[ .01. T!e interaction Das not si#nificant at 1,93P Q .&3),
Trial of Acupuncture 2eroin 3eto4ification
349
TA6.1 3
7ean ?umber of 3a,s in Treatment b, Treatment +onition an
Self-reports of :reIuenc, of 2eroin "se
Treatment
conition
Stanar S!am
acupunctu
re
acupunctu
re
Nn Q 55P Nn Q 45P
7 S3 7 S3
:reIuenc, of
use
.i#!t Nn Q
31P
).11 ).0& 3.0J 3.J&
7eium Nn Q
5&P
3.9& 4.10 1.%5 1.9)
2ea$, Nn Q 1
%P
&.&3 3.30 1.&5 .50
?ote5 7ain effects for bot! treatment conition an freIuenc,
of use Dere si#nificant at p [ .01.
p Q .%9. T!e #reat $ariabilit, in a,s in treatment Dit!in all
of t!e cells is reflecte in t!e lar#e stanar e$iations
reporte in t!e table.
Aitional A?>VAs Dere run for number of a,s in treatment
Dit! t!e folloDin# $ariables as separate co$ariates5 a#e,
#ener, et!nicit,, a#e at first use, an s,mptom score on t!e
first a, of treatment. ?one of t!ese factors Dere foun to
si#nificantl, effect t!e attenance measure.
>t!er >utcome 7easures
At intaLe, t!e urine samples of 4).5R of t!e stu, subFects
assi#ne to t!e s!am #roup an )1.1R of t!ose assi#ne to t!e
stanar #roup teste positi$e for opiates. NT!e urine samples
collecte from 3 subFects coul not be teste.P T!ese baseline
fi#ures Dere not si#nificantl, ifferent. 6ecause of t!e !i#!
attrition rates, feD samples Dere collecte urin# t!e secon
an t!ir DeeLs of treatment. >f t!e 4 urine samples from t!e
s!am #roup in t!e secon DeeL, & teste positi$e for opiates.
>f t!e 1% samples collecte from stanar subFects, 11 Dere
positi$e for opiates. 0f De assume t!at subFects for D!om De
lacL ata use !eroin urin# t!e secon DeeL, t!en t!e urine
samples of onl, 4.4R of t!e s!am an 10.9R of t!e stanar
#roup Dere ne#ati$e for opiates for t!is roun of testin#. :or
t!e t!ir DeeL, 1 of t!e 4 samples #i$en b, s!am subFects an
5 of t!e 9 samples from stanar subFects teste positi$e.
Percenta#e of LnoDn clean urines, t!en, for t!e t!ir DeeL Das
)J\'o for t!e s!am an %.3So for t!e stanar #roup.
Sie 1ffects
Total number of acupuncture treatments urin# t!e clinical
trial Das )0J. Sli#!t bleein# at t!e site of nee
le insertion Das not uncommon. >t!er sie effects Dere
infreIuent, !oDe$er, limite primaril, to mil nausea an
iMMiness. T!e acupuncture staff note relief of t!ese
conitions D!en t!e neeles Dere remo$e from subFectsE ears.
T!ere Dere no episoes of faintin# urin# t!e clinical trial
nor Dere an, #ra$e sie effectsTsuc! as infection at t!e site
of neele insertion or breaLin# of t!e neele uner t!e sLin T
obser$e.
30S+"SS0>? A?3 +>?+."S0>?S 1fficac, of Acupuncture
3eto4ification
T!e results presente !ere emonstrate t!at acupuncture
prouces a si#nificant effect in terms of treatment retention
D!en compare Dit! a s!am, or placebo, proceure. SubFects
recei$in# t!e stanar acupuncture treatment for aiction
attene t!e clinic more a,s t!an subFects in t!e s!am #roup.
T!is finin# is consistent Dit! t!ose note b, 6ullocL an !is
collea#ues in t!eir stuies of acupuncture-assiste alco!ol
eto4ification N6ullocL et al., 19J%19J9P, alt!ou#! t!e
effects of treatment conition on len#t!-of-sta, Dere less
pronounce in t!e ata reporte !ere. 6ullocLEs #roup Das able
to !ouse clients on an in-patient unit, creatin# a more stable
en$ironment for t!ose recei$in# treatment. Aitionall,, !is
#roup treate alco!olism D!ereas t!is stu, e4amine !eroin
aiction, Dit! man, of our subFects reportin# use of ot!er
ru#s as Dell.
>f si#nificance Das t!e finin# t!at li#!ter users attene
t!e acupuncture clinic more a,s an o$er a lon#er perio of
time t!an t!ose Dit! !ea$ier !abits. SubFects D!o inFecte
!eroin at least t!ree times a a, apparentl, foun t!at
acupuncture i not !elp relie$e Dit!raDal s,mptoms or reuce
cra$in# an, t!us, terminate treatment earl,. T!at t!is Das
true for subFects in bot! t!e stanar an s!am #roups
su##ests t!at t!e !ea$ier users ma, !a$e !a little
e4pectation t!at a ru#-free treatment moalit, Doul !elp
t!em. N8e iscuss t!is issue furt!er beloDC inee, De foun
t!at ini$iuals D!o inFecte !eroin at least t!ree times a
a, Dere less liLel, to $olunteer to participate in t!e stu,
t!an Dere t!e li#!ter users.P
Anot!er finin# of note Das t!at subFects recei$in# stanar
acupuncture Dere more liLel, t!an subFects recei$in# t!e s!am
treatment to return for aitional treatment be,on t!e &1-a,
eto4ification perio. Some of t!e clients recei$in# treatment
be,on t!e eto4ification episoe Dere usin# acupuncture as an
aFunct to met!aone eto4ification or maintenanceC ot!ers
seeme to seeL aitional treatment to eto4if, after relapse
to !eroin use. Since prolon#in# a clientEs treatment is
uniforml, re#are to be one of t!e primar, #oals of an, ru#
treatment pro#ram, t!e fin
350
A.7. 8as!burn et al.
in# t!at a number of subFects continue treatment Dell be,on
t!e &1-a, trial perio Darrants furt!er stu,.
.imitations of t!e Stu,
T!at +alifornia state laD pro!ibits unlicense acupuncturists
from aministerin# treatment mae it impossible to conuct a
ouble-blin trial. 0t is concei$able t!at at least part of
t!e effect of treatment conition foun in t!is stu, Das ue
to ifferential ent!usiasm of clinical staff for t!e stanar
o$er t!e Gs!amH protocol. 0n our Fu#ement, !oDe$er, t!e
effect of an, staff bias Das liLel, small5 Asie from t!e
particular acupuncture points use for treatment, stu,
subFects Dere treate t!e same in e$er, respect, e.#., all
recei$e t!e same ancillar, ser$ices.
A secon limitation of t!e stu, Das t!e !i#! attrition rate
for t!e stanar, as Dell as for t!e s!am, conition. :eDer
t!an one-fourt! of t!e stanar acupuncture clients remaine
in treatment be,on tDo DeeLs. >ne e4planation for t!e !i#!
attrition rate Das t!e fact t!at most of t!e mone, t!at
subFects recei$e for participatin# in t!e stu, Das ispense
on t!e first a, of treatmentC researc! staff foun t!at a
number of aicts seeme to !a$e $olunteere because t!e, Dere
reimburse for participation rat!er t!an because t!e, Dere
moti$ate for treatment.
Anot!er limitation Das t!at, because of insufficient
resources, De Dere unable to folloD up t!e subFects from t!e
tDo treatment #roups to etermine lon#-term effects, if an,,
of t!e eto4ification episoe. 8!at De i fin Das t!at
nearl, one-t!ir of t!e subFects assi#ne to t!e stanar
conition continue to seeL acupuncture treatment after
completin# t!e &1-a, trial.
:inall,, t!e finin# t!at t!e urine samples of onl, 53\'o of
t!e stu, subFects teste positi$e for opiates at intaLe
Darrants furt!er consieration. NT!ese ata are consistent,
!oDe$er, Dit! self-reports of ru# use in t!e 30 a,s
precein# treatment entr, Dit! nearl, a t!ir in eac! #roup
!a$in# inicate t!at t!e, use !eroin less t!an once ail,
]See Table 1^.P 8e reran t!e main anal,ses usin# onl, t!ose
subFects D!ose intaLe urine samples teste positi$e for
opiates. T!e principal finin#s for t!is sub#roup Dere t!e
same as for t!e #roup as a D!ole5 SubFects recei$in# t!e
stanar acupuncture treatment Nn Q 35P attene t!e clinic
si#nificantl, more a,s t!an subFects in t!e s!am #roup Nn Q
&1P Np [ .05P, an attenance Das #reater for li#!ter users
re#arless of treatment conition.
0t ma, be t!at !ea$ier users Dere reluctant to $olunteer for
t!e stu, for fear of recei$in# t!e s!am treatment.
Alternati$el,, t!e !ea$ier users ma, !a$e preferre met!aone-
supporte eto4ification, D!ile t!e ru#-free acupuncture
treatment Das attracti$e to opiate aicts Dit! li#!ter
!abits. :or D!ate$er reason, t!ose treate in t!is stu, ma,
not be represen
tati$e of aict populations seen in man, inner-cit, treatment
facilities.
+onclusions
8!ile t!e stu, reporte !ere foun a treatment effect in
terms of retention for subFects assi#ne to t!e stanar
acupuncture conition, De !a$e no e$ience t!at e$en t!ose D!o
complete t!e &1-a, pro#ram eto4ifie from !eroin. T!is is
not alto#et!er surprisin#. "nliLe met!aone eto4ification,
acupuncture is a ru#-free, rat!er t!an a replacement,
treatment. 7oreo$er, numerous stuies !a$e s!oDn t!at s!ort-
term, i.e., &1-a,, met!aone Dit!raDal is, at most, moestl,
successful NSorensen et al., 19J&C /oun- sa$ille, ;osten, O
;leber, 19J5PDit! !i#! attrition rates after t!e taperin#
p!ase of treatment be#ins. T!is treatment moalit, continues
to be Diel, use, !oDe$er, for a number of reasons. :or
e4ample, Dit! lon# Daitin# lists for met!aone maintenance
pro#rams at man, treatment facilities, met!aone
eto4ification is often t!e onl, option for man, patients.
/ecent researc! !as e$aluate $arious aFuncts to met!aone
eto4ification, as Dell as t!e relati$e merits of len#t!enin#
treatment be,on &1 a,s, to etermine !oD best to increase
its efficac, N0#uc!i O StitMer, 1991P.
Similar researc! is neee Dit! acupuncture ru# treatment.
<i$en t!e client acceptabilit, an t!e paucit, of sie
effects, acupuncture ma, be a feasible treatment moalit,
eit!er for li#!ter users or for se#ments of t!e !eroin-
aicte population for D!om met!aone is not a $iable option,
e.#., t!ose D!o o not Dant to, in effect, substitute one ru#
for anot!er. T!e 6a,$ieD-2unterEs Point Acupuncture +linic,
t!ou#! establis!e for purposes of t!is stu,, !as also
treate ini$iuals Dit! ot!er ru#-relate problems, suc! as
cocaine-aicte aults an infants, ini$iuals D!o abuse
alco!ol an prescription ru#s, an met!aone maintenance
patients. +linical e4perience Dit! eac! of t!ese #roups
su##ests t!at acupuncture ma, be a useful aFuncti$e t!erap,.
Aitional researc! is neee to etermine !oD acupuncture
mi#!t best be incorporate into compre!ensi$e substance abuse
treatment pro#rams.
/1:1/1?+1S
6ullocL, 7."men, A., +ulliton, P., O >laner, /. N19J%P. Acu-
puncture treatment of alco!olic recii$ism5 A pilot stu,.
Alco!olism5 +linical an 14perimental /esearc!, 5N11P, &9&-
&95. 6ullocL, 7H +ulliton, P., O >laner, /. N19J9P.
+ontrolle trial of acupuncture for se$ere recii$ist
alco!olism. T!e .ancet, J 1435-1439.
+lement-Jones, V., 7c.ou#!lin, ...oDre,, P., 6esser,
<./ees, .H O 8en, 2. N19%9P. Acupuncture in !eroin
aicts5 +!an#es in met-enLep!alin an beta-enorp!in in
bloo an cerebrospinal flui. T!e .ancet&, 3J0-3J&.
Trial of Acupuncture 2eroin 3eto4ification
351
+opolo$, 3.O 2elme, /. N19J3P. 1nLep!alins an enorp!ins5
+linical, p!armacolo#ical an t!erapeutic implications.
3ru#s, &)N)P 503-519.
0#uc!i, 7.@., O StitMer, 7l. N1991P. Preictors of opiate ru#
abuse urin# a 90-a, met!aone eto4ification. American
Journal of 3ru# an Alco!ol Abuse, 1%N3P&%9-&94.
;iser, /., ;!atami, 7.<atc!el, /.2uan#, X.6!atia, ;.O
Alts!uler, ;. N19J3P. Acupuncture relief of c!ronic pain
s,nrome correlates Dit! increase plasma met-enLep!alin
concentrations. T!e .ancet, &NJ3)4P, 1394-139).
;roeni#, /.J., O >leson, T.3. N19J5P. /api narcotic
eto4ification in c!ronic pain patients treate Dit!
auricular electroacupuncture an nalo4one. 0nternational
Journal of Aiction, &0 134%-)0.
.eDenber#, A. N19J5P. 1lectroacupuncture an antiepressant
treatment of alco!olism in a pri$ate practice. +linical
T!erap,, % )11-)1%.
7iller, 2.<H Turner, +.:., O 7oses, ..1. N1s.P. N1990P. A03S5
T!e secon ecae. 8as!in#ton, 3+5 ?ational Acaem, Press.
?eDme,er, J.A., Jo!nson, <..., ;lot, S., O 7oon, J. N19J1P.
Acupuncture as a eto4ification moalit,. "npublis!e
mono#rap!.
Pert, A., 3ionne, /.?#..6ra#in, 1.7oo,, T.8., O Pert,
+.6. N19J1P. Alterations in rat central ner$ous s,stem
enorp!ins folloDin# transauricular electroacupuncture. 6rain
/esearc!, &&4 J3-93.
/aDson, /.A., 7ann, A.J., Tennant, :.S., O +labou#!, 3.
N19J3P. 1fficac, of ps,c!ot!erapeutic counsellin# urin# &-
a, ambulator, !eroin eto4ification. 3ru# an Alco!ol
3epenence, 1&, 19%-&00.
/ounsa$ille, 6.J.E ;osten, T.O ;leber, 2. N19J5P. Success an
failure at outpatient opioi eto4ification5 1$aluatin# t!e
process of cloniine- an met!aone-assiste Dit!raDal. T!e
Journal of ?er$ous an 7ental 3iseases, 1%3N&P, 103-110.
Smit!, 7.O ;!an, 0. N19JJP. An acupuncture pro#ramme for t!e
treatment of ru#-aicte persons. 6ulletin on ?arcotics,
40N1P, 35-41.
Sorensen, J..., 2ar#rea$es, 8.A., O 8einber#, J.A. N19J&P.
8it!raDal from !eroin in t!ree or si4 DeeLs. Arc!i$es of
<eneral Ps,c!iatr,, 391)%-1%1.
Steiner, /.P. N19J3P. AcupunctureTcultural perspecti$es.
Post#rauate 7eicine, %4N4P, )0-%J.
Tennant, :.S. N19J)P. 6enefits of recurrent, outpatient !eroin
eto4ification. T!e 0nternational Journal of t!e Aictions,
&0N11O1&P, 1)J5-1)91.