The U.S. is currently facing an unprecedented epidemic of
opioid-related deaths. Despite the efficacy of the current treatments for
opioid use disorder (OUD), including psychosocial interventions and medication-assisted
therapy (MAT), many patients remain treatment-resistant and at high risk for overdose. A potential augmentation strategy includes the use of non-invasive brain stimulation (NIBS) techniques, such as
transcranial magnetic stimulation (TMS),
transcranial direct current stimulation (
tDCS), and auricular
vagus nerve stimulation (aVNS). These approaches may have therapeutic benefits by directly or indirectly modulating the neurocircuitry affected in OUD. In this review, we evaluate the available studies on NIBS in the context of OUD withdrawal and detoxification, maintenance, and cravings, while also considering
analgesia and safety concerns. In the context of
opioid withdrawal and detoxification, a percutaneous form of aVNS has positive results in open-label trials, but has not yet been tested against
sham. No randomized studies have reported on the safety and efficacy of NIBS specifically for maintenance treatment in OUD. TMS and
tDCS have demonstrated effects on cravings, although published studies were limited by small sample sizes. NIBS may play a role in reducing exposure to
opioids and the risk of developing OUD, as demonstrated by studies using
tDCS in an experimental
pain condition and TMS in a post-operative setting. Overall, while the preliminary evidence and safety for NIBS in the prevention and treatment of OUD appears promising, further research is needed with larger sample sizes, placebo control, and objective
biomarkers as outcome measures before strong conclusions can be drawn.