Opioid use disorder (OUD) incurs staggering harm to individuals, families, healthcare systems, and society. In Ontario (2020), opioids drove 2415 deaths and costs of $2.73 billion. Unfortunately, treatments are severely limited, with a ~70% relapse rate. An untapped approach is deep brain stimulation (DBS), a well-tolerated brain stimulation procedure to focally stimulate dysfunctional neurocircuitry. DBS has had Health Canada approval for over 25 years as a movement disorders treatment, but with little investigation in addiction. The Helping Addiction by Individualized Therapeutic Stimulation (HABITS) Study proposes to leverage next-generation DBS devices to stimulate critical brain circuits in treatment-resistant OUD while simultaneously recording brain signals that could guide therapy delivery. Given that each person with OUD is highly unique and treatment targets in the brain can vary, we propose to develop a new method to search for a personalized brain signature of opioid craving using stereoelectroencephalography, or sEEG, which uses a wide array of in-brain recording electrodes that are temporarily implanted to record brain states during high and low craving states. The goal with sEEG is to capture a novel craving brain activity signature that can then guide DBS target selection and programming settings in order to personalize treatment for each patient. We propose a pilot trial that aims to demonstrate the feasibility and safety of this highly complex and sophisticated approach that combines an individualized biomarker discovery with DBS treatment in an initial group of patients with OUD over a 6-month period, with secondary aims to explore possible clinical effectiveness. The HABITS study is well poised to discover novel mechanisms and develop brain-based approaches to alleviate the devastating burden of treatment-resistant OUD.
