Neuroethics

, Volume 4, Issue 2, pp 129–142 | Cite as

Ethical Issues Raised by Proposals to Treat Addiction Using Deep Brain Stimulation

  • Adrian Carter
  • Emily Bell
  • Eric Racine
  • Wayne Hall
Original Paper

Abstract

Deep brain stimulation (DBS) has been proposed as a potential treatment of drug addiction on the basis of its effects on drug self-administration in animals and on addictive behaviours in some humans treated with DBS for other psychiatric or neurological conditions. DBS is seen as a more reversible intervention than ablative neurosurgery but it is nonetheless a treatment that carries significant risks. A review of preclinical and clinical evidence for the use of DBS to treat addiction suggests that more animal research is required to establish the safety and efficacy of the technology and to identify optimal treatment parameters before investigating its use in addicted persons. Severely addicted persons who try and fail to achieve abstinence may, however, be desperate enough to undergo such an invasive treatment if they believe that it will cure their addiction. History shows that the desperation for a “cure” of addiction can lead to the use of risky medical procedures before they have been rigorously tested. In the event that DBS is used in the treatment of addiction, we provide minimum ethical requirements for clinical trials of its use in the treatment of addiction. These include: restrictions of trials to severely intractable cases of addiction; independent oversight to ensure that patients have the capacity to consent and give that consent on the basis of a realistic appreciation of the potential benefits and risks of DBS; and rigorous assessments of the effectiveness and safety of this treatment compared to the best available treatments for addiction.

Keywords

Addiction Deep brain stimulation Treatment Neurosurgery Neuroethics Consent Coercion 

References

  1. 1.
    Diefenbach, G.J., D. Diefenbach, A. Baumeister, and M. West. 1999. Portrayal of lobotomy in the popular press: 1935–1960. Journal of the History of the Neurosciences 8: 60–69.CrossRefGoogle Scholar
  2. 2.
    Racine, E., O. Bar-Ilan, and J. Illes. 2006. Brain imaging: A decade of coverage in the print media. Science Communication 28: 122–142.CrossRefGoogle Scholar
  3. 3.
    Racine, E., H.Z. van der Loos, and J. Illes. 2007. Internet marketing of neuroproducts: New practices and healthcare policy challenges. Cambridge Quarterly of Healthcare Ethics 16: 181–194.Google Scholar
  4. 4.
    Hall, W. 2000. UROD: An antipodean therapeutic enthusiasm. Addiction 95: 1765–1766.CrossRefGoogle Scholar
  5. 5.
    Hall, W. 2006. Stereotactic neurosurgical treatment of addiction: Minimising the chances of another ‘great and desperate cure’. Addiction 101: 1–3.Google Scholar
  6. 6.
    Talan, J. 2009. Deep brain stimulation: A new treatment shows promise in the most difficult cases. New York/Washington DC: Dana.Google Scholar
  7. 7.
    Bauer, R., S. Pohl, J. Klosterkotter, and J. Kuhn. 2008. Deep brain stimulation in the context of addiction—a literature-based systematic evaluation. Fortschritte der Neurologie-Psychiatrie 76: 396–401.CrossRefGoogle Scholar
  8. 8.
    Stelten, B.M., L.H. Noblesse, L. Ackermans, Y. Temel, and V. Visser-Vandewalle. 2008. The neurosurgical treatment of addiction. Neurosurgical Focus 25: E5.CrossRefGoogle Scholar
  9. 9.
    Lu, L., X. Wang, and T.R. Kosten. 2009. Stereotactic neurosurgical treatment of drug addiction. American Journal of Drug and Alcohol Abuse 35: 391–393.CrossRefGoogle Scholar
  10. 10.
    Yamada, K., T. Hamasaki, and J. Kuratsu. 2009. Subthalamic nucleus stimulation applied in the earlier vs. advanced stage of Parkinson’s disease—retrospective evaluation of postoperative independence in pursuing daily activities. Parkinsonism and Related Disorders 15: 746–751.CrossRefGoogle Scholar
  11. 11.
    Schupbach, W.M., D. Maltete, J.L. Houeto, S.T. du Montcel, L. Mallet, M.L. Welter, M. Gargiulo, C. Behar, A.M. Bonnet, V. Czernecki, B. Pidoux, S. Navarro, D. Dormont, P. Cornu, and Y. Agid. 2007. Neurosurgery at an earlier stage of Parkinson disease: A randomized, controlled trial. Neurology 68: 267–271.CrossRefGoogle Scholar
  12. 12.
    Food and Drug Administration. 2009. FDA approves humanitarian device exemption for deep brain stimulator for severe obsessive-compulsive disorder. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm149529.htm. Accessed 31 August 2009.
  13. 13.
    Servello, D., M. Porta, M. Sassi, A. Brambilla, and M.M. Robertson. 2008. Deep brain stimulation in 18 patients with severe Gilles de la Tourette syndrome refractory to treatment: The surgery and stimulation. Journal of Neurology, Neurosurgery and Psychiatry 79: 136–142.CrossRefGoogle Scholar
  14. 14.
    Visser-Vandewalle, V., L. Ackermans, C. van der Linden, Y. Temel, M.A. Tijssen, K.R. Schruers, P. Nederveen, M. Kleijer, P. Boon, W. Weber, and D. Cath. 2006. Deep brain stimulation in Gilles de la Tourette’s syndrome. Neurosurgery 58: E590.Google Scholar
  15. 15.
    Greenberg, B.D., D.A. Malone, G.M. Friehs, A.R. Rezai, C.S. Kubu, P.F. Malloy, S.P. Salloway, M.S. Okun, W.K. Goodman, and S.A. Rasmussen. 2006. Three-year outcomes in deep brain stimulation for highly resistant obsessive–compulsive disorder. Neuropsychopharmacology 31: 2384–2393.CrossRefGoogle Scholar
  16. 16.
    Lipsman, N., J.S. Neimat, and A.M. Lozano. 2007. Deep brain stimulation for treatment-refractory obsessive–compulsive disorder: The search for a valid target. Neurosurgery 61: 1–11. discussion 11–13.CrossRefGoogle Scholar
  17. 17.
    Mayberg, H.S., A.M. Lozano, V. Voon, H.E. McNeely, D. Seminowicz, C. Hamani, J.M. Schwalb, and S.H. Kennedy. 2005. Deep brain stimulation for treatment-resistant depression. Neuron 45: 651–660.CrossRefGoogle Scholar
  18. 18.
    Schlaepfer, T.E., M.X. Cohen, C. Frick, M. Kosel, D. Brodesser, N. Axmacher, A.Y. Joe, M. Kreft, D. Lenartz, and V. Sturm. 2008. Deep brain stimulation to reward circuitry alleviates anhedonia in refractory major depression. Neuropsychopharmacology 33: 368–377.CrossRefGoogle Scholar
  19. 19.
    Synofzik, M., and T.E. Schlaepfer. 2008. Stimulating personality: Ethical criteria for deep brain stimulation in psychiatric patients and for enhancement purposes. Biotechnology Journal 3: 1511–1520.CrossRefGoogle Scholar
  20. 20.
    Hamani, C., M.P. McAndrews, M. Cohn, M. Oh, D. Zumsteg, C.M. Shapiro, R.A. Wennberg, and A.M. Lozano. 2008. Memory enhancement induced by hypothalamic/fornix deep brain stimulation. Annals of Neurology 63: 119–123.CrossRefGoogle Scholar
  21. 21.
    Sani, S., K. Jobe, A. Smith, J.H. Kordower, and R.A. Bakay. 2007. Deep brain stimulation for treatment of obesity in rats. Journal of Neurosurgery 107: 809–813.CrossRefGoogle Scholar
  22. 22.
    Franzini, A., C. Marras, P. Ferroli, O. Bugiani, and G. Broggi. 2005. Stimulation of the posterior hypothalamus for medically intractable impulsive and violent behavior. Stereotactic and Functional Neurosurgery 83: 63–66.CrossRefGoogle Scholar
  23. 23.
    Quaade, F. 1974. Stereotaxy for obesity. The Lancet 303: 267–267.CrossRefGoogle Scholar
  24. 24.
    Capel, I.D., inventor Zion Foundation, assignee. 1984. Method and treatment with transcranially applied electrical signals United States Patent and Trademark Office patent 4,646,744. 1984 June 29.Google Scholar
  25. 25.
    Naqvi, N.H., D. Rudrauf, H. Damasio, and A. Bechara. 2007. Damage to the insula disrupts addiction to cigarette smoking. Science 315: 531–534.CrossRefGoogle Scholar
  26. 26.
    BBC News. 2007 Brain’s ‘addiction centre’ found. BBC News. 25 January: http://news.bbc.co.uk/2/hi/health/6298557.stm. Accessed 2 August 2007.
  27. 27.
    Robbins, T.W., R.N. Cardinal, P. DiCiano, P.W. Halligan, K.G.G. Hellemans, J.L. Lee, and B.J. Everitt. 2007. Neuroscience of drugs and addiction. In Drugs and the future: Brain science, addiction and society, ed. D. Nutt, T. Robbins, G. Stimson, M. Ince, and A. Jackson, 11–88. London: Academic.Google Scholar
  28. 28.
    Gao, G., X. Wang, S. He, W. Li, Q. Wang, Q. Liang, Y. Zhao, F. Hou, L. Chen, and A. Li. 2003. Clinical study for alleviating opiate drug psychological dependence by a method of ablating the nucleus accumbens with stereotactic surgery. Stereotactic and Functional Neurosurgery 81: 96–104.CrossRefGoogle Scholar
  29. 29.
    Liu, H.Y., J. Jin, J.S. Tang, W.X. Sun, H. Jia, X.P. Yang, J.M. Cui, and C.G. Wang. 2008. Chronic deep brain stimulation in the rat nucleus accumbens and its effect on morphine reinforcement. Addiction Biology 13: 40–46.CrossRefGoogle Scholar
  30. 30.
    Vassoler, F.M., H.D. Schmidt, M.E. Gerard, K.R. Famous, D.A. Ciraulo, C. Kornetsky, C.M. Knapp, and R.C. Pierce. 2008. Deep brain stimulation of the nucleus accumbens shell attenuates cocaine priming-induced reinstatement of drug seeking in rats. Journal of Neuroscience 28: 8735–8739.CrossRefGoogle Scholar
  31. 31.
    Knapp, C.M., L. Tozier, A. Pak, D.A. Ciraulo, and C. Kornetsky. 2009. Deep brain stimulation of the nucleus accumbens reduces ethanol consumption in rats. Pharmacology, Biochemistry & Behavior 92: 474–479.CrossRefGoogle Scholar
  32. 32.
    Rouaud, T., S. Lardeux, N. Panayotis, D. Paleressompoulle, M. Cador, and C. Baunez. 2010. Reducing the desire for cocaine with subthalamic nucleus deep brain stimulation. Proceedings of the National Academy of Sciences 107: 1196–1200.CrossRefGoogle Scholar
  33. 33.
    Baunez, C., C. Dias, M. Cador, and M. Amalric. 2005. The subthalamic nucleus exerts opposite control on cocaine and ‘natural’ rewards. Nature Neuroscience 8: 484–489.Google Scholar
  34. 34.
    Levy, D., M. Shabat-Simon, U. Shalev, N. Barnea-Ygael, A. Cooper, and A. Zangen. 2007. Repeated electrical stimulation of reward-related brain regions affects cocaine but not “natural” reinforcement. Journal of Neuroscience 27: 14179–14189.CrossRefGoogle Scholar
  35. 35.
    Witjas, T., C. Baunez, J.M. Henry, M. Delfini, J. Regis, A.A. Cherif, J.C. Peragut, and J.P. Azulay. 2005. Addiction in Parkinson’s disease: Impact of subthalamic nucleus deep brain stimulation. Movement Disorders 20: 1052–1055.CrossRefGoogle Scholar
  36. 36.
    Lim, S.Y., S.S. O’Sullivan, K. Kotschet, D.A. Gallagher, C. Lacey, A.D. Lawrence, A.J. Lees, D.J. O’Sullivan, R.F. Peppard, J.P. Rodrigues, A. Schrag, P. Silberstein, S. Tisch, and A.H. Evans. 2009. Dopamine dysregulation syndrome, impulse control disorders and punding after deep brain stimulation surgery for Parkinson’s disease. Journal of Clinical Neuroscience 16: 1148–1152.CrossRefGoogle Scholar
  37. 37.
    Halbig, T.D., W. Tse, P.G. Frisina, B.R. Baker, E. Hollander, H. Shapiro, M. Tagliati, W.C. Koller, and C.W. Olanow. 2009. Subthalamic deep brain stimulation and impulse control in Parkinson’s disease. European Journal of Neurology 16: 493–497.CrossRefGoogle Scholar
  38. 38.
    Ardouin, C., V. Voon, Y. Worbe, N. Abouazar, V. Czernecki, H. Hosseini, A. Pelissolo, E. Moro, E. Lhommee, A.E. Lang, Y. Agid, A.L. Benabid, P. Pollak, L. Mallet, and P. Krack. 2006. Pathological gambling in Parkinson’s disease improves on chronic subthalamic nucleus stimulation. Movement Disorders 21: 1941–1946.CrossRefGoogle Scholar
  39. 39.
    Smeding, H.M., A.E. Goudriaan, E.M. Foncke, P.R. Schuurman, J.D. Speelman, and B. Schmand. 2007. Pathological gambling after bilateral subthalamic nucleus stimulation in Parkinson disease. Journal of Neurology, Neurosurgery & Psychiatry 78: 517–519.CrossRefGoogle Scholar
  40. 40.
    Bannier, S., C. Montaurier, P.P. Derost, M. Ulla, J.J. Lemaire, Y. Boirie, B. Morio, and F. Durif. 2009. Overweight after deep brain stimulation of the subthalamic nucleus in Parkinson disease: Long term follow-up. Journal of Neurology Neurosurgery and Psychiatry 80: 484–488.CrossRefGoogle Scholar
  41. 41.
    Frank, M.J., J. Samanta, A.A. Moustafa, and S.J. Sherman. 2007. Hold your horses: Impulsivity, deep brain stimulation, and medication in Parkinsonism. Science 318: 1309–1312.CrossRefGoogle Scholar
  42. 42.
    Morgan, J.C., C.J. diDonato, S.S. Iyer, P.D. Jenkins, J.R. Smith, and K.D. Sethi. 2006. Self-stimulatory behavior associated with deep brain stimulation in Parkinson’s disease. Movement Disorders 21: 283–285.CrossRefGoogle Scholar
  43. 43.
    Olds, J., and P. Milner. 1954. Positive reinforcement produced by electrical stimulation of septal area and other regions of rat brain. Journal of Comparative and Physiological Psychology 47: 419–427.CrossRefGoogle Scholar
  44. 44.
    Heinze, H.J., M. Heldmann, J. Voges, H. Hinrichs, J. Marco-Pallares, J.M. Hopf, U.J. Muller, I. Galazky, V. Sturm, B. Bogerts, and T.F. Munte. 2009. Counteracting incentive sensitization in severe alcohol dependence using deep brain stimulation of the nucleus accumbens: Clinical and basic science aspects. Frontiers in Human Neuroscience 3: 22.CrossRefGoogle Scholar
  45. 45.
    Kuhn, J., R. Bauer, S. Pohl, D. Lenartz, W. Huff, E.H. Kim, J. Klosterkoetter, and V. Sturm. 2009. Observations on unaided smoking cessation after deep brain stimulation of the nucleus accumbens. European Addiction Research 15: 196–201.CrossRefGoogle Scholar
  46. 46.
    Kuhn, J., D. Lenartz, W. Huff, S. Lee, A. Koulousakis, J. Klosterkoetter, and V. Sturm. 2007. Remission of alcohol dependency following deep brain stimulation of the nucleus accumbens: Valuable therapeutic implications? Journal of Neurology, Neurosurgery and Psychiatry 78: 1152–1153.CrossRefGoogle Scholar
  47. 47.
    Xu, J. 2007. Therapeutic effect of deep brain stimulation of the nucleus accumbens on refractory drug addiction: A case report. Neuromodulation: Technology at the Neural Interface, 8th World Congress of the International Neuromodulation Society; 2007 December 9–12, 2007; Acapulco, Mexico.Google Scholar
  48. 48.
    Müller, U.J., V. Sturm, J. Voges, H.J. Heinze, I. Galazky, M. Heldmann, H. Scheich, and B. Bogerts. 2009. Successful treatment of chronic resistant alcoholism by beep brain stimulation of nucleus accumbens: First experience with three cases. Pharmacopsychiatry 42: 288–291.CrossRefGoogle Scholar
  49. 49.
    Bell, E., and E. Racine. 2007. Ethics in deep brain stimulation for alcohol dependence. Journal of Neurology, Neurosurgery and Psychiatry 78: 1152–1153.CrossRefGoogle Scholar
  50. 50.
    Strang, J., N. Metrebian, N. Lintzeris, L. Potts, T. Carnwath, S. Mayet, H. Williams, D. Zador, R. Evers, T. Groshkova, V. Charles, A. Martin, and L. Forzisi. 2010. Supervised injectable heroin or injectable methadone versus optimised oral methadone as treatment for chronic heroin addicts in England after persistent failure in orthodox treatment (RIOTT): A randomised trial. Lancet 375: 1885–1895.CrossRefGoogle Scholar
  51. 51.
    Valenstein, E.S. 1986. Great and desperate cures: The rise and decline of psychosurgery and other radical treatments for mental illness. New York: Basic Books.Google Scholar
  52. 52.
    Balasubramaniam, V., T.S. Kanaka, and P.B. Ramanujam. 1973. Stereotaxic cingulumotomy for drug addiction. Neurology India 21: 63–66.Google Scholar
  53. 53.
    Foltz, E.L., and L.E. White Jr. 1962. Pain “relief” by frontal cingulumotomy. Journal of Neurosurgery 19: 89–100.CrossRefGoogle Scholar
  54. 54.
    Kanaka, T.S., and V. Balasubramaniam. 1978. Stereotactic cingulumotomy for drug addiction. Applied Neurophysiology 41: 86–92.Google Scholar
  55. 55.
    Sharma, T. 1974. Abolition of opiate hunger in humans following bilateral anterior cingulotomy. Texas Medicine 70: 49–52.Google Scholar
  56. 56.
    Dieckmann, G., and H. Schneider. 1978. Influence of stereotactic hypothalamotomy on alcohol and drug addiction. Applied Neurophysiology 41: 93–98.Google Scholar
  57. 57.
    Muller, D., F. Roeder, and H. Orthner. 1973. Further results of stereotaxis in the human hypothalamus in sexual deviations. First use of this operation in addiction to drugs. Neurochirurgia 16: 113–126.Google Scholar
  58. 58.
    Knight, G. 1969. Chronic depression and drug addiction treated by stereotactic surgery. Nursing Times 65: 583–586.Google Scholar
  59. 59.
    Walsh, N.P. 2002. Russia bans brain surgery on drug addicts. The Guardian. 9 August: http://education.guardian.co.uk/higher/medicalscience/story/0,,771816,00.html. Accessed 11 February 2007.
  60. 60.
    Xinhua News Agency. 2005. Brain surgery not resuming for curing drug addicts: Health ministry. Xinhua News Agency.Google Scholar
  61. 61.
    Orellana, C. 2002. Controversy over brain surgery for heroin addiction in Russia. Lancet Neurology 1: 333.CrossRefGoogle Scholar
  62. 62.
    Goff, P. 2005. ‘I was conscious as they pushed the needle deep into my brain’. Telegraph. 19 November: http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2005/11/20/wbrain20.xml. Accessed 6 July 2007.
  63. 63.
    Medvedev, S.V., A.D. Anichkov, and I. Poltakov Iu. 2003. Physiological mechanisms of the effectiveness of bilateral stereotactic cingulotomy in treatment of strong psychological dependence in drug addiction. Fiziologiia Cheloveka 29: 117–123.Google Scholar
  64. 64.
    Nutt, D., and A. Lingford-Hughes. 2008. Addiction: The clinical interface. British Journal of Pharmacology 154: 397–405.CrossRefGoogle Scholar
  65. 65.
    Lingford-Hughes, A., S. Welch, and D. Nutt. 2004. Evidence-based guidelines for the pharmacological management of substance misuse, addiction and comorbidity: Recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology 18: 293–335.CrossRefGoogle Scholar
  66. 66.
    McNeely, H.E., H.S. Mayberg, A.M. Lozano, and S.H. Kennedy. 2008. Neuropsychological impact of Cg25 deep brain stimulation for treatment-resistant depression: Preliminary results over 12 months. Journal of Nervous and Mental Disease 196: 405–410.CrossRefGoogle Scholar
  67. 67.
    Smeding, H.M., J.D. Speelman, M. Koning-Haanstra, P.R. Schuurman, P. Nijssen, T. van Laar, and B. Schmand. 2006. Neuropsychological effects of bilateral STN stimulation in Parkinson disease: A controlled study. Neurology 66: 1830–1836.CrossRefGoogle Scholar
  68. 68.
    Kenney, C., R. Simpson, C. Hunter, W. Ondo, M. Almaguer, A. Davidson, and J. Jankovic. 2007. Short-term and long-term safety of deep brain stimulation in the treatment of movement disorders. Journal of Neurosurgery 106: 621–625.CrossRefGoogle Scholar
  69. 69.
    Agid, Y., M. Schupbach, M. Gargiulo, L. Mallet, J.L. Houeto, C. Behar, D. Maltete, V. Mesnage, and M.L. Welter. 2006. Neurosurgery in Parkinson’s disease: The doctor is happy, the patient less so? Journal of Neural Transmission Supplementum 70: 409–414.CrossRefGoogle Scholar
  70. 70.
    Schupbach, M., M. Gargiulo, M.L. Welter, L. Mallet, C. Behar, J.L. Houeto, D. Maltete, V. Mesnage, and Y. Agid. 2006. Neurosurgery in Parkinson disease: A distressed mind in a repaired body? Neurology 66: 1811–1816.CrossRefGoogle Scholar
  71. 71.
    Abelson, J.L., G.C. Curtis, O. Sagher, R.C. Albucher, M. Harrigan, S.F. Taylor, B. Martis, and B. Giordani. 2005. Deep brain stimulation for refractory obsessive–compulsive disorder. Biological Psychiatry 57: 510–516.CrossRefGoogle Scholar
  72. 72.
    Gisquet, E. 2008. Cerebral implants and Parkinson’s disease: A unique form of biographical disruption? Social Science and Medicine 67: 1847–1851.CrossRefGoogle Scholar
  73. 73.
    Bell, E., B. Maxwell, A. Sadikot, M. McAndrews, and E. Racine. 2010. Healthcare providers perspectives and approaches. Journal of Clinical Ethics 21: 113–125.Google Scholar
  74. 74.
    Racine, E., S. Waldman, N. Palmour, D. Risse, and J. Illes. 2007. “Currents of hope”: Neurostimulation techniques in U.S. and U.K. print media. Cambridge Quarterly of Healthcare Ethics 16: 312–316.Google Scholar
  75. 75.
    Badenoch, J. 2002. A death following ultra-rapid opiate detoxification: The General Medical Council adjudicates on a commercialized detoxification. Addiction 97: 475–477.CrossRefGoogle Scholar
  76. 76.
    Hamilton, R.J., R.E. Olmedo, S. Shah, O.L. Hung, M.A. Howland, J. Perrone, L.S. Nelson, N.L. Lewin, and R.S. Hoffman. 2002. Complications of ultrarapid opioid detoxification with subcutaneous naltrexone pellets. Academic Emergency Medicine 9: 63–68.CrossRefGoogle Scholar
  77. 77.
    Bell, E., G. Mathieu, and E. Racine. 2009. Preparing the ethical future of deep brain stimulation. Surgical Neurology 72: 577–586.CrossRefGoogle Scholar
  78. 78.
    Rabins, P., B.S. Appleby, J. Brandt, M.R. DeLong, L.B. Dunn, L. Gabriels, B.D. Greenberg, S.N. Haber, P.E. Holtzheimer, Z. Mari, H.S. Mayberg, E. McCann, S.P. Mink, S. Rasmussen, T.E. Schlaepfer, D.E. Vawter, J.L. Vitek, J. Walkup, and D.J.H. Mathews. 2009. Scientific and ethical issues related to deep brain stimulation for disorders of mood, behavior, and thought. Archives of General Psychiatry 66: 931–937.CrossRefGoogle Scholar
  79. 79.
    Schlaepfer, T.E., and J.J. Fins. 2010. Deep brain stimulation and the neuroethics of responsible publishing: When one is not enough. JAMA 303: 775–776.CrossRefGoogle Scholar
  80. 80.
    Mattick, R.P., C. Breen, J. Kimber, and M. Davoli. 2009. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database of Systematic Reviews 3: CD002209.Google Scholar
  81. 81.
    Mattick, R.P., J. Kimber, C. Breen, and M. Davoli. 2008. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database of Systematic Reviews 2: CD002207.Google Scholar
  82. 82.
    Carter, A., and W. Hall. 2008. Informed consent to opioid agonist maintenance treatment: Recommended ethical guidelines. International Journal of Drug Policy 19: 79–89.CrossRefGoogle Scholar
  83. 83.
    Lintzeris, N. 2009. Prescription of heroin for the management of heroin dependence: Current status. CNS Drugs 23: 463–476.CrossRefGoogle Scholar
  84. 84.
    Carter, A., and W. Hall. 2007. The ethical use of psychosocially assisted pharmacological treatment of opioid dependence. Geneva: World Health Organization.Google Scholar
  85. 85.
    Carter, A., and W. Hall. 2007. The social implications of neurobiological explanations of resistible compulsions. American Journal of Bioethics 7: 15–17.Google Scholar
  86. 86.
    National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. 1977. Psychosurgery: Reports and recommendations. Washington, D.C.: US Government Printing Office.Google Scholar
  87. 87.
    Baltuch, G.H., and M.B. Stern. 2007. Deep brain stimulation for Parkinson’s disease. New York: Informa Healthcare.Google Scholar
  88. 88.
    Australian Bureau of Statistics. 2007. National survey of mental health and wellbeing: Summary of results. Canberra: Australian Bureau of Statistics.Google Scholar
  89. 89.
    Perozzo, P., M. Rizzone, B. Bergamasco, L. Castelli, M. Lanotte, A. Tavella, E. Torre, and L. Lopiano. 2001. Deep brain stimulation of subthalamic nucleus: Behavioural modifications and familiar relations. Neurological Sciences 22: 81–82.CrossRefGoogle Scholar
  90. 90.
    Okun, M., R. Rodriguez, K. Foote, A. Sudhyadhom, F. Bova, C. Jacobson, B. Bello, P. Zeilman, and H. Fernandez. 2008. A case-based review of troubleshooting deep brain stimulator issues in movement and neuropsychiatric disorders. Parkinsonism and Related Disorders 14: 532–538.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Adrian Carter
    • 1
  • Emily Bell
    • 2
  • Eric Racine
    • 2
    • 3
    • 4
  • Wayne Hall
    • 5
  1. 1.UQ Centre for Clinical ResearchThe University of QueenslandHerstonAustralia
  2. 2.Neuroethics Research UnitInstitut de recherches cliniques de MontréalMontréalCanada
  3. 3.Department of Medicine and Department of Social and Preventive MedicineUniversité de MontréalMontréalCanada
  4. 4.Departments of Neurology and Neurosurgery, Medicine, and Biomedical Ethics UnitMcGill UniversityMontréalCanada
  5. 5.UQ Centre for Clinical Research and Queensland Brain InstituteThe University of QueenslandBrisbaneAustralia

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