tDCS to Decrease Opioid Relapse

Buprenorphine has emerged as a leading treatment for opioid use disorder (OUD), but recipients have high
early relapse rates likely due to varying degrees of dysfunction within craving and cognitive control neuronal
networks. Transcranial direct current stimulation (tDCS) may have promise as adjuvant treatment for
buprenorphine initiators because considerable work on addictive substances suggests treatment targeted at the
dorsolateral prefrontal cortex (DLPFC; region involved in self-regulation) may reduce craving and drug
consumption. We will measure behavioral and brain responses following tDCS stimulation to the DLPFC
delivered during cognitive control network (CCN) priming. Participants in their first week of prescribed
buprenorphine will be assessed twice using FMRI, once prior to tDCS+CCN priming and again at the
completion of 5 sessions of tDCS+CCN priming (one week later). Task-based and resting state functional
connectivity will be used to examine networks associated with craving (CR) and cognitive control. In the UG3
phase (n=60), FMRI will provide validation of expected changes in these networks following tDCS stimulation.
Go/no go criteria for the UH3 phase will be demonstration of greater FMRI change in any node of the CR or
CCN networks AND greater change in subjective craving measured prior to (outside FMRI scan) or during an
FMRI cue reactivity task following the tDCS+CCN priming intervention compared to sham tDCS+CCN
priming. In the UH3 phase (n=100), we will perform a larger RCT (vs. sham control) to address long-term
neurobehavioral outcomes, including opioid relapse, craving, and sustained fMRI changes. Because tDCS is
safe, inexpensive and portable, if this intervention provides FMRI validation of targeted brain effects and
produces clinical response, it could have great impact augmenting the care of persons entering buprenorphine
treatment, a population at high risk for treatment failure.

Grant Number: 5UH3DA047793-05
NIH Institute/Center: NIH
Principal Investigator: Ana Abrantes