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Review
. 2023 Mar:113:103964.
doi: 10.1016/j.drugpo.2023.103964. Epub 2023 Feb 10.

Treating addiction with deep brain stimulation: Ethical and legal considerations

Clara Lo  1 , Mansee Mane  2 , Jee Hyun Kim  3 , Michael Berk  3 , Richard R Sharp  4 , Kendall H Lee  5 , Jason Yuen  6
Affiliations
Review

Treating addiction with deep brain stimulation: Ethical and legal considerations

Clara Lo et al. Int J Drug Policy. 2023 Mar.

Abstract

Background: The use of neuromodulation in the treatment of psychiatric conditions is controversial despite its lengthy history. This particularly applies to the use of invasive neuromodulation, such as deep brain stimulation (DBS), to treat substance use disorder (SUD) due to the considerable risks of the procedures. However, given the advances in DBS research and the shortcomings of current treatment modalities for addiction, off-label use and clinical trials are being implemented for the management of treatment-refractory patients.

Methods: Here we conduct an ethical and legal analysis of DBS for SUD, referencing the four foundational principles of medical ethics and key legal concepts.

Results: There are major concerns related to the capacity of a SUD patient to provide informed consent, as well as the risks and benefits of DBS compared to traditional treatment methods. In addition to ethical concerns, we explore potential legal issues that may arise from DBS in the treatment of addiction. These include the potential mandate of these procedures in the context of the criminalization of substance use, and the issue of familial consent in the decision-making process. Given the paucity of relevant clinical guidelines or legal cases, general medico-legal principles serve as the reference in making decisions about the responsible use of DBS as a treatment for addiction.

Conclusions: Given the rapidly increasing evidence for DBS as a treatment for SUD, it is an urgent imperative to consider the relevant key ethical and legal issues. Incorporating IDEAL (Idea, Development, Exploration, Assessment, Long-term follow-up) framework into future research in DBS is recommended to evaluate patient safety and ethical perspectives. With the broad criminalization of SUD across the globe, legal coercion of DBS is not impossible, especially if proven to be effective to treat SUD. It is advised for stakeholders to urgently consider incorporating DBS-related drug policies so that the potential benefits of DBS within the rights of people with SUD are not hindered by the lack of clinical guidance and legislations.

Keywords: Addiction; Bioethics; Deep brain stimulation; Neuromodulation; Neuropsychiatry; Substance abuse.

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Conflict of interest statement

Declarations of Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1.
Figure 1.
Summary of the key events that shaped the history of neuromodulation in psychiatric disorders.
Figure 2.
Figure 2.
Main treatment options that addiction patients are recommended depending on the source of their addiction. * denotes non-FDA approved treatment methods.
See this image and copyright information in PMC

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