GESTIÓN EN SALUD PÚBLICA: BioEdge: US researchers trial deep brain stimulation for opioid use

domingo, 10 de noviembre de 2019

BioEdge: US researchers trial deep brain stimulation for opioid use

BioEdge: US researchers trial deep brain stimulation for opioid use

Bioedge

US researchers trial deep brain stimulation for opioid use

by Michael Cook | 10 Nov 2019 |

^{Gerod Buckhalter being wheeled into surgery}

A West Virginia-based research team has launched the first American clinical trial of deep brain stimulation for patients suffering from treatment-resistant opioid use.

They successfully implanted a Medtronic DBS device in the addiction and reward centre of the brain of Gerod Buckhalter, a 33-year-old man who has struggled with substance use disorder, specifically excessive opioid and benzodiazepine use, for more than a decade. He has had many overdoses and relapses.

West Virginia has the highest age-adjusted rate of drug overdose deaths involving opioids. In 2017, drug overdose deaths involving opioids in West Virginia occurred at a rate of 49.6 deaths per 100,000 persons. Dr Rezai told the BBC:

"Addiction is complex, there are a range of social dynamics at play and genetic elements and some individuals will have a lack of access to treatments so their brains will slowly change and they will have more cravings.
"This treatment is for those who have failed every other treatment, whether that is medicine, behavioural therapy, social interventions. It is a very rigorous trial with oversight from ethicists and regulators and many other governing bodies."

In the US, overdoses are the main cause of death for under-50s. "Over half of patients relapse,” says Dr Rezai. “We need to find solutions because it is a life-threatening situation and something which impacts family and loved ones."

DBS, or brain pacemaker surgery, involves implantation of tiny electrodes into specific brain areas to regulate the structures involved in addiction and behavioral self-control. In the words of Dr Rezai, it is a "pacemaker for the brain”.

This study, which involves four patients, will also investigate the mechanism of the addiction in the brain. The FDA has approved DBS for treating patients with Parkinson's disease, essential tremor, dystonia, epilepsy, and obsessive-compulsive disorder.

Michael Cook is editor of BioEdge

It sounds like the premise for a Stephen King novel, but it’s real life. Benjamin Schreiber, a 66-year-old man, is serving a life sentence for murder in an Iowa prison. Back in 1996, he bludgeoned a man to death with an axe handle. In 2015 he suddenly became seriously ill, so ill that he lapsed into a coma and “died”.

But he recovered. Disappointed that he was still alive, he appealed to have his life sentence voided as it had already “expired”.

It’s an intriguing argument. Can you live two lives? Are you the same person after being resuscitated? Or are you literally a dead man walking?

Unfortunately for Schreiber, the court took a dim view of his request.

“We do not find his argument persuasive,” wrote a judge this week. She concluded: “Schreiber is either still alive, in which case he must remain in prison, or he is actually dead, in which case this appeal is moot.”

This ruling will allow the citizens of Iowa to sleep easier at night, but philosophically isn’t a bit naive in the way it addresses the problem of identity? Isn’t it possible that Mr (1996) Schreiber is dead and that Mr (2019) Schreiber is a different person? If S(2019) identifies as a dead person, shouldn’t we accept his carefully considered opinion?