Research Question

  1. What are the efficacy and safety of needle acupuncture, as an adjunctive or monotherapy, in reducing relapse, frequency and quantity of substance use, withdrawal symptoms, treatment dropout, and adverse events, and improving functional status and health-related quality of life in adults with alcohol, opioid, stimulant, or cannabis use disorders compared with active treatments, sham acupuncture, treatment as usual, wait lists, or no treatment?

RAND researchers conducted a systematic review that synthesized evidence from randomized controlled trials of needle acupuncture — used adjunctively or as monotherapy — to provide estimates of its efficacy and safety for treating adults diagnosed with alcohol, opioid, stimulant, or cannabis use disorder. Outcomes of interest included relapse, frequency and quantity of substance use, withdrawal symptoms, treatment dropout, functional status, health-related quality of life, and adverse events. When possible, meta-analyses and meta-regressions were conducted using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Quality of evidence was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. Forty-one trials (reported in 48 publications) with 5,227 participants were included. The available evidence suggests no consistent effect of acupuncture versus comparator interventions on substance use outcomes. There were positive effects for withdrawal symptoms and anxiety, yet these results were based on low or very low quality of evidence. Meta-regressions indicated that treatment dropout results differed by substance targeted, and withdrawal/craving symptoms and treatment dropout differed by acupuncture type. We found no evidence to suggest that effects of needle acupuncture differed systematically by acupuncture when offered as adjunctive versus monotherapy or by type of comparator. Only 12 studies provided safety data, and these data suggest that acupuncture is not typically associated with serious adverse events. Given the quality of evidence, there is uncertainty with regard to the magnitude or stability of effect estimates.

Key Findings

The Available Evidence Did Not Yield Consistent Effects for Substance Use Outcomes

  • There was evidence of the effectiveness of needle acupuncture on some psychosocial outcomes (namely, withdrawal/craving and anxiety), though the body of evidence for these results is of low to very low quality.
  • We found no robust evidence to suggest that effects of needle acupuncture differed systematically as an adjunctive therapy or monotherapy, or by the type of comparator.
  • The available evidence suggests that acupuncture is not typically associated with serious adverse events, though adverse events were rarely assessed.
  • The generally poor methodological quality of the body of evidence prevents any strong conclusions about needle acupuncture for substance use disorders.

Recommendations

  • More well-designed, rigorous, and large randomized controlled trials are needed in order to develop an evidence base that can more decisively provide estimates of the effectiveness of acupuncture for substance use disorders.
  • Future randomized controlled trials incorporating military-related eligibility criteria could provide more-applicable evidence to decisionmakers in military and veteran health systems.
  • Researchers should consider the potential effect of participant expectancies about acupuncture on intervention outcomes, and future randomized controlled trials should be reported in compliance with the Standards for Reporting Interventions in Controlled Trials of Acupuncture.
  • Researchers, policymakers, funders, and practitioners may wish to convene in order to decide the priorities (if any) for future research on needle acupuncture for substance use disorders.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Methods

  • Chapter Three

    Results

  • Chapter Four

    Discussion

  • Appendix A

    Search Strategy

  • Appendix B

    Evidence Table of Included Studies

  • Appendix C

    Cochrane Risk of Bias Criteria

  • Appendix D

    Excluded Full-Text Articles

  • Appendix E

    Additional Forest and Funnel Plots

This research was sponsored by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury and conducted within the Forces and Resources Policy Center of the RAND National Defense Research Institute, a federally funded research and development center sponsored by the Office of the Secretary of Defense, the Joint Staff, the Unified Combatant Commands, the Navy, the Marine Corps, the defense agencies, and the defense Intelligence Community.

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