Doctors at the Rambam Health Care Campus in Haifa have successfully treated their first Israeli opioid addiction patient using an experimental noninvasive brain technology, easing him through withdrawal in just 20 minutes.
H., a 40-year-old family man from northern Israel, was injured in his neck several years ago. Because of the injury, he relied on painkillers and eventually became addicted to them.
“Over time the pain lessened, but he could not break free from the dependence on the pills and the doses kept increasing, until they reached a peak of about 130 pills a day,” Dr. Amir Minerbi, director of the Pain Medicine Institute at Rambam, explained. The painkiller detox clinic that treated H. operates out of the institute. “H. was no longer suffering from pain. He simply needed that substance in his blood so he would be calm and able to function.”
During the innovative treatment performed at Rambam, the team of specialists at the Haifa medical center intervened in the electrical activity of an area of the patient’s brain called the nucleus accumbens, the core of the brain system responsible for feelings of satisfaction, pleasure, and reward. The treatment, based on technology from the Israeli company Insightec, is similar to the one used to treat symptoms of essential tremor and Parkinsonian tremor, under MRI control.
In this case, the treatment was carried out with the help of a new technology that performs noninvasive neuromodulation, without heating or burning tissue, and allows stimulation in the same area of the brain to increase or suppress activity.
“The new technology allows us to intervene in the brain’s electrical activity in a targeted way, and thereby influence focused control areas in brain activity, depending on the disease being treated,” said Dr. Lior Lev-Tov, director of the functional neurosurgery unit in Rambam’s neurosurgery division and the one leading the new study at the medical center.
“Already during the treatment itself we identified a decrease in the patient’s craving for the drug. Tests carried out a week later produced negative results for opioids and other substances. The patient himself reported a craving score of zero out of 10 for using the drug, and even another side effect, a drastic drop in the desire for cigarettes, from three packs a day to just a few cigarettes, and with no urge to use alcohol. In other words, in a treatment that lasted about 20 minutes net, our patient was completely freed from an extreme dependence that had accompanied him every day for years. This is nothing less than a medical and therapeutic revolution.”
The opioid crisis is a global epidemic
Opioid addiction has been defined as a global epidemic, and in the United States it has claimed the lives of hundreds of thousands of people, with damage estimated at about $60 billion each year. In Israel, which only a few years ago ranked first in the world for the rate of growth in opioid use, the trend has been halted and is now declining.
“Opioid painkillers are used effectively to treat short-term pain, and they are an important tool in medicine for those who need them,” Minerbi explained. “A small but significant portion of painkiller users may develop an addiction to opioids, meaning they want to take the drug again and again, regardless of how it affects pain. Among those who take the drug over time, it becomes less effective for pain treatment, and it contributes to increasingly developing side effects such as harm to the lungs, an increased and premature risk of death, damage to the ability to integrate into the circle of life, a decline in quality of life, and more.”
“Today, detox from painkillers works in two ways: tapering off until stopping use, with success rates of 5%, while even those who manage to quit remain at risk of illness and death afterward,” he added. “The second option is to use an alternative drug that works through the same mechanism as the drug to which the patients developed an addiction. Detox has two stages: physical detox, which refers to withdrawal symptoms, and psychological detox, which may last a long time. The new development specifically targets areas in the brain that are responsible for addiction. We hope it will be able to help thousands who are dependent on opioids in a safer and less traumatic way.”
As noted, the study is being conducted at three centers in the United States as part of a multicenter trial that has so far produced excellent results in preserving treatment gains and detox from opioids. Some of the patients were even addicted to heroin, a drug whose detox process can last for years. H., the first Israeli patient, was also the first to undergo the treatment while in active withdrawal, a therapeutic challenge that contributed significant insights to the international study.
“From the moment of treatment until today he has been clean from use of the drug. The urge and craving to use the drug disappeared completely and we are happy for his happiness,” Dr. Lev-Tov reported. “He told us that he got his life back. The tests show that the body is completely clean and the patient’s physical and functional condition is completely normal.”
He added: “We are talking about a noninvasive ability to reach very deep and very sensitive areas, as part of a very complex network in the brain that is linked to reward, satisfaction, desire and the ability to control needs and impulses, and we are able to move the range from one end to the other. There is nothing like it in the world of medicine. This experience opens doors for us to treat a wide range of very serious illnesses such as PTSD, OCD, eating disorders, other addictions, severe depression, severe pain disorders, and I hope we will also be able to reach cognitive areas and treat attention deficit disorders, Alzheimer’s, Parkinson’s, and more.”
“This is a new therapeutic platform that allows us to offer a range of noninvasive treatments for a variety of problems that affect many people around the world,” Dr. Lev-Tov stressed. “A scientific breakthrough of the highest order that is still expected to affect us greatly and change the way we approach treating human beings. The patients I mentioned have enormous potential to return to full rehabilitation, live full lives, start families, return to the workforce, and move Israel and the entire world forward.”
He concluded: “Rambam is a global pioneer in the use of FUS technology and has become a center of excellence in the field. One that will continue to push the technology forward and make breakthrough treatment accessible to patients in additional indications. There is nothing more ethical or correct than leveraging existing technologies, finding the patient who can benefit from them, breaking boundaries, and daring. That is what we do here on a daily basis.”
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