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The Available Evidence Did Not Yield Consistent Effects for Substance Use Outcomes

• There was evidence of the effectiveness of needle acupuncture on some psychosocial outcomes (namely, withdrawal/craving and anxiety), though the body of evidence for these results is of low to very low quality.
• We found no robust evidence to suggest that effects of needle acupuncture differed systematically as an adjunctive therapy or monotherapy, or by the type of comparator.
• The available evidence suggests that acupuncture is not typically associated with serious adverse events, though adverse events were rarely assessed.
• The generally poor methodological quality of the body of evidence prevents any strong conclusions about needle acupuncture for substance use disorders.

RAND researchers conducted a systematic review that synthesized evidence from randomized controlled trials of needle acupuncture — used adjunctively or as monotherapy — to provide estimates of its efficacy and safety for treating adults diagnosed with alcohol, opioid, stimulant, or cannabis use disorder. Outcomes of interest included relapse, frequency and quantity of substance use, withdrawal symptoms, treatment dropout, functional status, health-related quality of life, and adverse events. When possible, meta-analyses and meta-regressions were conducted using the Hartung-Knapp-Sidik-Jonkman method for random-effects models. Quality of evidence was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach. Forty-one trials (reported in 48 publications) with 5,227 participants were included. The available evidence suggests no consistent effect of acupuncture versus comparator interventions on substance use outcomes. There were positive effects for withdrawal symptoms and anxiety, yet these results were based on low or very low quality of evidence. Meta-regressions indicated that treatment dropout results differed by substance targeted, and withdrawal/craving symptoms and treatment dropout differed by acupuncture type. We found no evidence to suggest that effects of needle acupuncture differed systematically by acupuncture when offered as adjunctive versus monotherapy or by type of comparator. Only 12 studies provided safety data, and these data suggest that acupuncture is not typically associated with serious adverse events. Given the quality of evidence, there is uncertainty with regard to the magnitude or stability of effect estimates.

• Chapter One

  Introduction

• Chapter Two

  Methods

• Chapter Three

  Results

• Chapter Four

  Discussion

• Appendix A

  Search Strategy

• Appendix B

  Evidence Table of Included Studies

• Appendix C

  Cochrane Risk of Bias Criteria

• Appendix D

  Excluded Full-Text Articles

• Appendix E

  Additional Forest and Funnel Plots