Repetitive transcranial magnetic stimulation in the treatment of opioid use disorder: A narrative review

It is estimated that over 16 million people are living with opioid use disorder (OUD) worldwide, with 2.1 million people in the United States. Opioid addiction is theorized to be associated with strong dopaminergic response to opioid receptor stimulations that contributes to reward-seeking behaviors and individuals' experiences with opioids. Methadone and buprenorphine have been game changers; however, both come with limitations, especially in the era of fentanyl use. Naltrexone is another treatment used for OUD that blocks opioid receptors. An emerging treatment of significant interest is a neuro-interventional technique called transcranial magnetic stimulation (TMS), which is currently approved by the Food and Drug Administration for the treatment of depression and, recently, for obsessive compulsive disorder and tobacco use disorder. TMS has been seen in some studies to significantly reduce cravings for opioids with effects beyond the last administrated treatment. This manuscript is a narrative review of the potential relevance of TMS, specifically, repetitive TMS, in the future treatment of OUD.