Ping Gong, L.Ac., Yuhang Qi, L.Ac.

Fentanyl is an extremely potent synthetic opioid, approximately 100 times more potent than morphine and 50 times more so than heroin [1]. Introduced into the U.S. clinical medical system in the 1960s as an effective intravenous anesthetic, fentanyl plays an irreplaceable role in the medical field [2]. However, its illegal manufacturing and distribution have turned it into a significant public health threat in the United States. In 2022, Anne Milgram, head of the Drug Enforcement Administration (DEA), identified fentanyl as the “single deadliest drug threat” the U.S. has faced [3]. Fentanyl and other opioids have driven the most severe drug crisis in American history, causing over 1,500 Americans to die from opioid overdoses each week, and it is the leading cause of death for Americans aged 18 to 45. In 2021, the total number of deaths soared to 80,411 [4]. A study by researchers from the Mayo Clinic and Yale University found that deaths caused solely by fentanyl nearly tripled from 2016 to 2021 [5].

Extensive animal and clinical trial data confirm that acupuncture can significantly improve the withdrawal symptoms from opioids. Acupuncture, including both traditional and electroacupuncture therapies, can hasten the production and release of opioid peptides in the central nervous system, thereby achieving analgesic effects. This outcome is closely related to the stimulation frequency of electroacupuncture. Low-frequency stimulation (2Hz) can accelerate the production of endorphins and enkephalins in the central nervous system, while high-frequency stimulation (100Hz) can speed up the production of dynorphin [6]. By accelerating the release of various opioid peptides in the central nervous system, acupuncture alleviates the withdrawal syndrome in individuals addicted to opioid drugs. It is well known that drug dependence is a problem that can reoccur over time, with a high likelihood of relapse even after a period of abstinence. Therefore, the ultimate goal of treating drug dependence is not only to alleviate or cure withdrawal symptoms but more importantly, to reduce the craving for drugs (psychological dependence) and eliminate compulsive drug-seeking behaviors after detoxification [7].

From the perspective of Traditional Chinese Medicine (TCM), opioids are pungent, warm, and dry. Consumption leads to intense toxic heat within the body, disturbing the mind and creating abnormal excitement, seemingly bringing pleasure to the mind and body. However, this internal accumulation of toxic heat damages the essence and consumes the blood, ultimately harming the yin and yang and injuring the vital energy. Without continued consumption, withdrawal syndrome appears, manifesting as listlessness, fatigue, excessive sleepiness, restlessness, indecisiveness, abnormal emotional fluctuations (such as depression, despair, and dejection), loss of interest in daily activities, frequent sighing, sadness, sleep disorders (difficulty falling or staying asleep), anxiety, irritability, slow reactions, and in severe cases, emotional instability, inability to work or socialize normally, and even self-destructive tendencies. In addition to psychological and emotional abnormalities, physical abnormalities also emerge, including frequent headaches, dizziness, chest tightness, palpitations, shortness of breath, loss of appetite, nausea, vomiting, and more, due to deficits in qi, blood, yin, and yang, and dysfunction of internal organs.

In clinical practice, combining acupuncture with herbal medicine and adopting a method of supporting the healthy and expelling the pathogenic have achieved certain therapeutic effects in treating withdrawal syndrome from fentanyl and other opioids, as well as in preventing relapse. Below is a typical case analysis:

The patient, a 36-year-old female, initially accidentally consumed Percocet laced with fentanyl and quickly developed a dependence on fentanyl. The patient described experiencing extremely painful withdrawal symptoms, encompassing a wide range of physical and mental symptoms such as anxiety, insomnia, cold sweats, muscle pain, nausea, vomiting, diarrhea, involuntary crying, and yawning. The intensity and range of these states once led the patient to despair. The acupuncture and Chinese herbal medicine treatment was as follows:

Acupuncture points chosen included LI-4 (He Gu), PC-8 (Lao Gong), PC-6 (Nei Guan), M-HN-3 (Yin Tang), SP-6 (San Yin Jiao), ST-36 (Zu San Li) on the abdominal side, BL-15 (Xin Shu), BL-18 (Gan Shu), BL-23 (Shen Shu), and the Jia Ji points (T3-T5) on the back side. The patient first lay in a supine position for needle insertion, twisting and thrusting to achieve de qi sensation, followed by electroacupuncture stimulation on certain points, connecting LI-4 (He Gu) to PC-8 (Lao Gong) and SP-6 (San Yin Jiao) to ST-36 (Zu San Li). The stimulation used alternating waves of 2Hz and 100Hz frequencies, adjusting the current strength based on the patient’s tolerance. After leaving the needles in for 20 minutes, the patient was placed in a prone position for backside acupuncture points, leaving the needles in for another 20 minutes without electroacupuncture stimulation. Auricular acupuncture followed the National Acupuncture Detoxification Association (NADA) protocol, targeting five points: Shenmen, Sympathetic, Kidney, Liver, and Lung, with the needles left in place for 40 minutes. As an adjunct therapy, Chinese herbal medicine was used: Gui Pi Wan was prescribed, mainly to calm the Shen, strengthen the spleen, and harmonize yin and yang. The dosage was 8 pills taken twice daily, morning and evening, with warm water.

In the first week, treatment was administered three times, and according to the patient’s feedback, there was a significant improvement in withdrawal symptoms, with a decreased desire for drugs. From the second to the third week, treatment was reduced to twice weekly, with further improvement in various symptoms. Based on the symptoms, the herbal formula was switched to Gan Mai Da Wan Wan, and the patient was also taught Tai Chi to help calm the mind, stabilize emotions, and enhance physical strength. After four and a half months of continuous treatment, significant overall improvement was noted, and the patient returned to normal life, at which point treatment was discontinued. A follow-up call six months later confirmed the patient’s satisfaction, with a return to normal work and life activities and no relapse into drug use.

Reference

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Choińska, M. K., Šestáková, I., Hrdlička, V., Skopalová, J., Langmaier, J., Maier, V., & Navrátil, T. (2022). Electroanalysis of fentanyl and its new analogs: a review. Biosensors, 12(1), 26.

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