Auricular acupuncture for cocaine dependence: Cochrane systematic review
Assessed as up to date: 2005/10/27
Auricular acupuncture (insertion of acupuncture into a number, usually five, of specific points in the ear) is a widely-used treatment for cocaine dependence.Objectives
To determine whether auricular acupuncture is an effective treatment for cocaine dependence, and to investigate whether its effectiveness is influenced by the treatment regimen.Search strategy
We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004); MEDLINE (January 1966 to October 2004) , EMBASE (January 1988 to October 2004); PsycInfo (1985 to October 2004); CINAHL (1982 to October 2004); SIGLE (1980 to October 2004) and reference lists of articles.Selection criteria
Randomised controlled trials comparing a therapeutic regimen of auricular acupuncture with sham acupuncture or no treatment for reduction of cocaine use in cocaine dependents.Data collection and analysis
Two authors independently extracted data from published reports and assessed study quality using the Drug and Alcohol CRG checklist. All authors were contacted for additional information; two provided data. Separate meta-analyses were conducted for studies comparing auricular acupuncture with sham acupuncture, and with no treatment. For the main cocaine use outcomes, analyses were conducted by intention to treat, assuming that missing data were treatment failures. Available case analyses, using only individuals who provided data, were also conducted.Main results
Seven studies with a total of 1,433 participants were included. All were of generally low methodological quality. No differences between acupuncture and sham acupuncture were found for attition RR 1.05 (95% CI 0.89 to 1.23) or acupuncture and no acupuncture: RR 1.06 (95% CI 0.90 to 1.26) neither for any measure of cocaine or other drug use. However, the number of participants included in meta-analyses was low, and power was limited. Moderate benefit or harm is not ruled out by these results. Methodological limitations of the included studies may have also made the results open to bias.Authors' conclusions
There is currently no evidence that auricular acupuncture is effective for the treatment of cocaine dependence. The evidence is not of high quality and is inconclusive. Further randomised trials of auricular acupuncture may be justified.
Gates Simon, Smith Lesley A, Foxcroft David
Auricular acupuncture for cocaine dependence
There are no effective drugs for the treatment of cocaine dependence, and doctors do not agree on a best method of treatment. More than 400 substance abuse clinics in the USA and Europe offer a treatment for cocaine dependence called auricular acupuncture. In this treatment, needles are usually inserted into five specific points in the ear, but some clinics use only four or three of the points. In this Cochrane review the authors set out to discover whether auricular acupuncture is effective in treating cocaine dependence and whether the number of points used makes a difference. The authors searched the medical literature for studies called randomized controlled trials, in which one group of patients receives a treatment (such as acupuncture) and is compared with a similar group who receives a different treatment or no treatment (the control group). The authors found seven studies with a total of 1433 people. Most of the studies compared acupuncture with 'sham' acupuncture in which needles were inserted into random places in the ear but not into the specific points required for treatment. The studies used a variety of acupuncture techniques, using three, four, or five of the treatment points. The studies had a number of problems with the way their results were reported. The authors conclude that there is no evidence that any form of auricular acupuncture is effective for treating cocaine dependence. They recommend that better research be done, since it was difficult for them to draw conclusions from the few available studies.
Implications for practice
There is no evidence that auricular acupuncture is effective as a treatment for cocaine dependence. However, the evidence is not of high quality and is not conclusive. The widespread use of acupuncture is not based on sound evidence.
Implications for research
Further randomised trials of auricular acupuncture for cocaine dependence are warranted. These should use a sample size large enough to detect modest effects, include long-term follow up and endeavour to minimise losses to follow up. Participants who withdraw from treatment should be included in follow up. Studies should be fully reported according to the CONSORT guidelines. It is questionable whether a trial of acupuncture versus sham acupuncture is a meaningful comparison as sham acupuncture may have some treatment effects similar to true acupuncture and would not be used in clinical practice. Consideration should be given to cluster randomised designs comparing clinics providing a specified package of services for cocaine dependence including acupuncture with clinics providing a similar package without acupuncture.Get full text at The Cochrane Library
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