Acupuncture reduces methadone dose and opioid cravings in patients undergoing methadone maintenance therapy

Embargoed for release until 5:00 p.m. ET on Monday 8 July 2024    
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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.    
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1. Acupuncture reduces methadone dose and opioid cravings in patients undergoing methadone maintenance therapy

Abstract: https://www.acpjournals.org/doi/10.7326/M23-2721

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According to the results of a randomized, controlled trial, acupuncture may facilitate reducing methadone maintenance dose and reduce drug cravings for patients undergoing treatment for opioid addiction. These findings are important because while MMT has been widely used to decrease the use of opioids, suppress withdrawal symptoms, and reduce criminal activities, it is also a long-term treatment associated with harsh side-effects that make ongoing treatment difficult for patients. The study is published in Annals of Internal Medicine.

Researchers from South China Research Center for Acupuncture and Moxibustion and Medical College of Acu-Moxi and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou randomly assigned xx participants to either acupuncture or sham acupuncture 3 times a week for 8 weeks to assess the efficacy of acupuncture on methadone dose reduction. The researchers looked specifically for a reduction in methadone dose of 20% or more compared with baseline and a reduction in an opioid craving score. They found that the administration of acupuncture resulted in meaningful improvements in the amount of methadone reduction and the decrease in opioid craving score when compared with sham acupuncture. According to the authors, the findings support the consideration of acupuncture for methadone reduction for persons who are receiving MMT.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with one of the corresponding authors, Liming Lu, PhD or Nenggui Xu,MD, please email lulimingleon@126.com or lulimingleon@gzucm.edu.cn.

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2. Apixaban may offer safety benefits over both rivaroxaban and warfarin in patients with cirrhosis and atrial fibrillation

Abstract: https://www.acpjournals.org/doi/10.7326/M23-3067    

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A nationwide cohort study found that among patients with cirrhosis and nonvalvular atrial fibrillation (AF), initiating treatment with anticoagulant therapy, apixaban, may offer a safety benefit compared with rivaroxaban or warfarin. These findings are important because AF affects more than 15% of patients with cirrhosis and many of them are prescribed a DOAC (direct oral anticoagulant), such as apixaban or rivaroxaban. However, no large studies focused on cirrhosis and AF have directly compared the two DOACs and warfarin. The study is published in Annals of Internal Medicine.

Researchers from Brigham and Women's Hospital, Harvard Medical School studied data from two U.S. claims data sets to compare the effectiveness and safety of apixaban versus rivaroxaban and versus warfarin in patients with cirrhosis and AF. Patient data was assessed for ischemic stroke or systemic embolism and major hemorrhage (intracranial hemorrhage or major gastrointestinal bleeding).  The data showed that patients initiating rivaroxaban treatment had significantly higher rates of major hemorrhagic events than those initiating treatment with apixaban. Specifically, rivaroxaban initiators had 47% higher rates of major hemorrhagic events compared with apixaban initiators. Similarly, warfarin initiators had 38% higher rates of major hemorrhage compared with apixaban initiators, including a 2.9-fold higher rate of hemorrhagic stroke. The incidence of ischemic events was similar among all groups. According to the authors, these findings suggest apixaban may offer greater relative safety benefits, and this could help guide clinical care for a patient population that has lacked sufficient data to inform treatment selection.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Kueiyu Joshua Lin, MD, ScD, MPH, please email jklin@bwh.harvard.edu.

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