Drug overdoses kill more than 100,000 in the US 1:23
Morgantown, West Virginia (CNN) --
As her son walked up the steep stone steps and through the front door of the home he shared with his mother and father, Gina Buckhalter was wary.
It was no secret that Gerod used drugs heavily and he had been addicted to opioids for more than half of his 33 years.
Gina was used to surprises, but this day brought a big one.
"She told me: 'They suggested I have a brain operation for addiction,'" she recalls.
"And she literally wanted to pass out on the floor."
"They" were a research team from the Rockefeller Neuroscience Institute, based at West Virginia University, about 10 miles away, across the state line from Buckhalter's home in Dilliner, Pennsylvania.
Buckhalter was already a patient at the institute, where he was treated by Dr. James Mahoney, a substance abuse specialist.
Over the years, Buckhalter had tried time and time again to get sober, but the most he had achieved was three months in a row.
Most of the time he only lasted a few days clean.
A new study of spinal cord stimulation makes people with paralysis walk again
His problems started very young.
Buckhalter grew up in Dilliner, a nervous, anxious kid who was both a basketball and soccer star, with Major League scholarship offers in the 10th grade.
The local newspaper dubbed him "Mr. Everything".
In Buckhalter's senior year, that dream was dashed.
An injury to his shoulder at the age of 15 led to prescriptions for opioid painkillers.
His doctors prescribed the pills for six weeks.
Later, Buckhalter got them on his account.
advertising
By age 20, Buckhalter was using heroin and drugs were the only thing on his mind.
When Mahoney proposed surgery, Buckhalter
was at the end of his strength.
"Immediately, I said, 'Yeah, let's do it.' Immediately. Because that's how desperate I was," Buckhalter told CNN Medical Correspondent Dr. Sanjay Gupta.
Soon after, Buckhalter became the first patient in a four-person research study to test the safety and feasibility of deep brain stimulation, or DBS, as an addiction treatment.
The study is funded by a $750,000 grant from the National Institute on Drug Abuse.
Early in the morning of November 1, 2019, Dr. Ali Rezai, a neurosurgeon and director of Rockefeller, drilled a hole in Buckhalter's skull.
He inserted an electrical probe, a thin piece of wire barely a millimeter wide.
Then, with the tube in place, he began the real work.
As Buckhalter lay sedated but awake, Rezai showed him a series of images on a monitor: scores of drugs and other images meant to induce the cravings and anxiety that had haunted Buckhatler for 17 years.
Based on Buckhalter's answers, Rezai adjusted the probe, a little to the left, now a little higher, to make sure he was in the right position.
The team hoped that the electrical signal would restore healthy function to damaged brain areas and free Buckhalter from the relentless craving that was holding him prisoner.
What is the ECP
Deep brain stimulation (DBS) is widely used to treat Parkinson's disease and is approved by the US Food and Drug Administration (FDA) to treat a number of other conditions, including severe epilepsy and obsessive-compulsive disorder.
Brain stimulation worked "like a switch" to deactivate a patient's severe depression
But substance use disorder presents a more complex set of emotional and behavioral challenges.
Dr. Nora Volkow, director of the National Institute on Drug Abuse, says that deep brain stimulation was first tested in a small group of drug users in China, but little was known about long-term results.
For Buckhalter and Rezai, the gamble was worth it.
"There are people dying, 100,000 a year," says Rezai.
"These people were at risk of dying from another overdose. And for those severe end-stage cases, DBS becomes an option."
Dilliner and Morgantown are in the heart of the coal belt, a region that has been particularly hard hit by the overdose crisis.
Overdose death rates in West Virginia have been more than double the national rate for at least six years, and the gap is growing.
Between June 2020 and June 2021, annual overdose deaths soared nearly 32% in West Virginia, compared to a 21% increase in the United States as a whole.
The latest interim data from the US Centers for Disease Control and Prevention (CDC) shows that overdose death rates are now about three times higher in West Virginia than the rate national.
In the United States, more than 100,000 people died from drug overdoses between June 2020 and June 2021, according to the CDC.
Synthetic opioids, such as fentanyl, were involved in nearly two-thirds of those deaths.
Addiction counseling and medications help many people, but Rezai says some need extra help to break the cycle of drug dependence.
As he explains, the brain of a drug user physically changes over time.
One of the changes occurs in the nucleus accumbens, which helps regulate the function of a neurotransmitter called dopamine, vital to what is known as the brain's reward system.
This is the brain circuitry that leads us to eat, fall in love or perform a rewarding task, that is, anything that requires a minimum of motivation.
Motivation, reward, satisfaction.
For some people, that includes drug use.
"The first time you take drugs, you get a dopamine rush," explains Rezai.
"But the more drugs you take, the less [dopamine] there is."
In susceptible individuals, the result is intense craving and obsessive behavior.
"The nucleus [accumbens] becomes hyperactive, to look for dopamine."
Rezar hopes that by placing the electrical probe in the nucleus accumbens, normal function will be restored.
The probe also stimulates a second region of the brain, the frontal cortex, which is vital for higher-order thinking and decision-making, and which Rezai says is also damaged by excessive drug use.
What is fentanyl, the drug fueling the US overdose epidemic?
Other studies, beyond the ECP
Deep brain stimulation is just one approach to reversing these changes.
Other research subjects are receiving transcranial magnetic stimulation, in which current is delivered through a device placed on the outside of the head.
The technique has been approved by the FDA since 2008 to treat major clinical depression and since 2018 for obsessive-compulsive disorder.
A handful of pilot studies found it could reduce cravings for using alcohol, nicotine, opiates or cocaine, according to Mahoney, Buckhalter's doctor.
Another experimental approach is focused ultrasound.
Using high or low frequency energy waves, the technique can reach brain structures much deeper than those accessible by transcranial magnetic stimulation.
It's like deep brain stimulation, but without the risk of surgery.
Its use as an addiction treatment, however, is still theoretical.
In the deep brain stimulation study, once the probe is implanted, subjects, including Buckhalter, can allow researchers to record their brain activity in real time.
"It's a live broadcast," Rezai said.
"With biofeedback, we're starting to model these digital biomarkers for addiction, craving and anxiety."
Although the models are in their infancy, the goal is to find indicators that can warn doctors and patients that a relapse is approaching.
Doctors can then remotely adjust the strength and placement of the electrical current from the probe for better effect.
It has worked for Buckhalter.
The man who never got past three months of sobriety has now been drug-free for two and a half years.
Deep brain stimulation is part of his accomplishment, but he also takes a drug called suboxone, goes to therapy and has a steady job at a sobriety home, support he says has been critical: "When it comes to staying sober , it is as important as the surgery".
OPINION |
Advice from a psychologist: how to talk to your children about social networks and drug use?
Of the other three people in the study, one had much the same success as Buckhalter, but another relapsed and had the catheter removed.
For the most recent patient, it's too early to tell.
Rezai says that he is preparing a larger study, with more than a dozen people.
Amid the spate of overdose deaths, a study with just four people might seem like a drop in the bucket.
A $50,000 surgical intervention is not a substitute for a supportive family nor does it guarantee that people have food and a safe place to sleep.
And it doesn't begin to address the question of whether deadly overdoses could be curbed by changing drug laws that push users onto the fentanyl black market.
But Volkow, of the National Institute on Drug Abuse, argues that basic medical research can still play an important role: "Regardless of whether this reaches the clinic in a significant way, it can translate into less expensive and less invasive methods," he said. .
"Neuromodulation is very promising."
He also says that it is not about choosing one or the other.
Surgical procedures "are not a panacea for the overdose crisis, but studies like [the DBS] help us understand what drives drug use and inspire the development of new addiction treatments."
For Rex Buckhalter, Gerod's father, "it feels good to wake up and not have to worry about him."
Editor's Note:
This report was produced in collaboration with the Global Health Reporting Center.
Deidre McPhillips contributed to this report.
Medical treatment for drug addicts