Can HBOT help patients on methadone or Suboxone to taper off and complete medication-assisted treatment with less opioid withdrawal discomfort?
What is hyperbaric oxygen therapy? HBOT is a component of hyperbaric medicine, a form of treatment that doctors have used since the mid-20th century. Patients enter a pressure chamber that can deliver 100% pure oxygen for treatment.
HBOT chambers provide an ambient pressure higher than atmospheric pressure. The therapy raises oxygen levels and increases blood flow by angiogenesis. Getting more oxygen delivered throughout the body makes HBOT ideal for treating damaged tissue and preventing further damage.
How does HBOT help with medical problems?
Originally, hyperbaric oxygen therapy was developed to treat problems associated with SCUBA diving. These problems included decompression sickness and gas embolisms.
Researchers have studied HBOT for decades, learning that it can be useful for a variety of conditions. These include chronic ulcers, brain injuries, gas gangrene, carbon monoxide poisoning, hearing problems, radiation injuries, and even cancer.
It is interesting to note that hyperbaric oxygen therapy may help with COVID-19. Hyperbaric Air, a related treatment, was used successfully to treat patients with the Spanish flu in 1918.
How do we know that it can help with opioid withdrawal?
Researchers at Washington State had already studied HBOT with morphine-dependent mice. The scientists administered naloxone, the active ingredient in Narcan, to the mice. Giving the mice naloxone caused precipitated withdrawal. The mice that received HBOT had fewer withdrawal symptoms.
Also, these researchers were aware of the benefits of hyperbaric oxygen therapy. For example, it reduces the neuroinflammation associated with traumatic brain injuries. With an understanding of opioid withdrawal effects on the central nervous system and their previous experiments with mice, they prepared to take the next steps.
The scientists conducted their experiment with patients taking methadone as part of an MAT program. During the study, they tapered methadone doses for the subjects. Some subjects received HBOT while others did not.
We should note that methadone tapering is particularly tricky.
The severe, prolonged withdrawal symptoms associated with methadone are due to the long half-life of the drug.
The Clinical Opioid Withdrawal Scale (COWS) was used to assess the patients before and after the 90-minute sessions in HBOT. Subjects engaged in hyperbaric therapy for five consecutive days.
After a single session, researchers noted a significant reduction in opioid withdrawal symptoms for the patients who received HBOT. There was a two-fold reduction in the severity of symptoms for these patients.
While further studies are needed, the results of the Washington State University study are intriguing. The medication-assisted treatment drugs, methadone, and buprenorphine do cause significant withdrawal symptoms. There has not been nearly enough attention given to the process of helping patients complete therapy with these medications.
Naltrexone, another MAT drug for alcohol and drug addiction, does not cause a withdrawal syndrome. But, it is more difficult to start treatment for opioid addiction with naltrexone.
Methadone and buprenorphine are highly effective in treating substance abuse.
Yet, many patients are concerned about how they will complete treatment comfortably when the time comes to taper off of the treatment drug. If we have multiple strategies for making the tapering process more manageable, patients will be more willing to get started. Either way, the dangers of drug abuse far outweigh any issues associated with MAT.
Should I get started with HBOT now?
While the risks of hyperbaric oxygen treatment are relatively low, there are some risks associated with the high-pressure environment. Barotrauma to the lungs, ears, and sinuses are possible. Oxygen toxicity is another risk.
The high cost is another consideration. Each session can cost as much as several hundred dollars, and health insurance will not cover this cost for now.
Hopefully, in the future, costs will come down as HBOT becomes more of a mainstream treatment option for opioid withdrawal syndrome. Easing the process of tapering from MAT will make Suboxone and methadone treatment much more acceptable as well.