According to the World Drug Report 2018, approximately 31 million people are affected by opioid use disorders through the world, which cause the greatest burden of severe disease and drug-related deaths worldwide [
1]. In China, there are approximately 2.5 million people using illicit drugs, of which opioids and methamphetamines represent the majority [
2].
Opioid dependence is a chronic psychiatric disorder. Discontinuation of the drug abruptly induces specific physiological and psychological changes called withdrawal, which is a temporary stage opposing intoxication towards re-establishment of the patient’s neuronal system. Withdrawal symptoms mainly include sweating, shaking and diarrhoea in the first few days, accompanied by dysphoria, depression, anxiety and insomnia, which may continue for several months [
3,
4]. It is an unadaptable state associated with withdrawal symptoms and severe craving, which may lead to the high risk of relapse. The primary goal of treatment for opioid dependence usually focuses on achieving control of withdrawal symptoms and reducing cravings. Methadone has been used to treat withdrawal symptoms for several decades. Patients with opioid dependence have to receive MMT as replacement therapy for years or even their entire life. However, side effects of MMT still exist and have been reported to range widely, especially during the early weeks of methadone stabilization [
5]. Patients often complain of insomnia and cravings during MMT, which contribute to the risk of relapse [
6]. Therefore, it is necessary to seek a new treatment with efficacy and safety for patients receiving MMT.
Acupuncture has been applied to treat diseases in China for thousands of years, gaining popularity in Western countries as an alternative and complementary therapy [
7]. In 1996, the World Health Organization accepted that acupuncture, as a kind of therapy, is appropriate for the treatment of drug use disorders [
8]. Compared with drug treatment, acupuncture for opioid dependence has zero side effects and is convenient and inexpensive [
9]. Acupuncture may inhibit the activation of specific brain regions related to drug craving, which support its potential as a therapy for drug craving [
10]. Liang Yan reported that acupuncture may alleviate the depression and anxiety associated with heroin dependence [
11]. Some basic studies have revealed that acupuncture might potentially reduce relapse through inhibiting attention bias to heroin [
12], lowering complications of drug dependence [
13] and modifying the morphine withdrawal syndrome [
14]. To our knowledge, JTN, a type of acupuncture technique, has been applied to treat diseases for decades and has formed a school of acupuncture technique in South China. The concept of ‘mind’ means mental activities in traditional Chinese medicine (TCM). JTN is able to treat mental diseases and help patients to regulate the mind [
15]. JTN has been widely used to ameliorate depression and anxiety [
16]. A previous study reported that JTN treatment may ameliorate insomnia [
17]. We hypothesize that patients receiving JTN will have reductions in drug craving, require less methadone during MMT and have improvements in quality of life, sleep quality, depression and anxiety. Therefore, this study aims to evaluate the efficacy and safety of acupuncture as an adjunctive therapy for patients receiving MMT.