Homeopathy for Substance Use Disorders? No, I don’t think so!

This review assessed the role of homoeopathy in the therapeutic management of substance use disorders (SUD) through a systematic web-based literature search. A comprehensive search was conducted online and manually to identify homoeopathic research studies published between 1993 and 2022 on SUD in international databases and the Central Council of Research in Homoeopathy library. Relevant studies were categorised and assessed in terms of study designs, number of participants, evidence grades and clinical outcome parameters. A total of 21 full-text studies were screened and evaluated. Risk of bias (RoB) was assessed for all studies and model validity was appraised for the included RCTs’.

10 studies were included:

• 3 Randomised Controlled Trials,
• 3 Observational studies,
• 1 Pilot study,
• 1 observational comparative study,
• 1 retrospective cohort study,
• 1 case series.

Three studies have a level of evidence of 1b with an ‘A’ grade of recommendation, which consists of the RCTs only. The most commonly prescribed medicines identified were:

• Arsenic album,
• Nux vomica,
• Lycopodium,
• Pulsatilla,
• Sulphur,
• Staphysagria,
• Belladonna,
• Ipecac,
• Chamomilla,
• Rhustox,
• Phosphorus,
• Lachesis.

A high risk of bias was elicited in most of the observational studies accentuating the need for more robust methodological studies.
The authors concluded that the majority of the studies have a small number of recruitments. Pragmatic studies with larger sample sizes and validated outcome measures may be designed further to validate the
promising role of homoeopathic medicines in SUDs and generate quality evidence.

The paper is surprising! Most of the studies are not RCTs and thus cannot come even near suggesting a causal effect of homeopathy. The three RCTs are the following:

• Manchanda RK, Janardanan Nair KR, Varanasi R, Oberai P, Bhuvaneswari R, Bhalerao R, et al. A randomised comparative trial in the management of alcohol dependence: Individualised homoeopathy versus standard allopathic treatment. Indian J Res Homoeopathy; 2016.
• Adler UC, Acorinte AC, Calzavara FO, et al. Double-blind evaluation of homeopathy on cocaine craving: A randomised controlled pilot study. J Integr Med. 2018; 16(3):178-184.
• Grover A, Bhushan B, Goel R. Double-blind placebo-controlled trial of homoeopathic medicines in the
  management of withdrawal symptoms in opium addicts and its alkaloid derivatives dependents. Indian J Res Homoeopathy. 2009;3:41-4.

All of these 3 studies were assessed by the review authors as having major flaws. Only one is available on Medline:

Background: Brazil is among the nations with the greatest rates of annual cocaine usage. Pharmacological treatment of cocaine addiction is still limited, opening space for nonconventional interventions. Homeopathic Q-potencies of opium and Erythroxylum coca have been tested in the integrative treatment of cocaine craving among homeless addicts, but this setting had not proven feasible, due to insufficient recruitment.

Objective: This study investigates the effectiveness and tolerability of homeopathic Q-potencies of opium and E. coca in the integrative treatment of cocaine craving in a community-based psychosocial rehabilitation setting.

Design, setting, participants, and interventions: A randomized, double-blind, placebo-controlled, parallel-group, eight-week pilot trial was performed at the Psychosocial Attention Center for Alcohol and Other Drugs (CAPS-AD), Sao Carlos/SP, Brazil. Eligible subjects included CAPS-AD patients between 18 and 65 years of age, with an International Classification of Diseases-10 diagnosis of cocaine dependence (F14.2). The patients were randomly assigned to two treatment groups: psychosocial rehabilitation plus homeopathic Q-potencies of opium and E. coca (homeopathy group), and psychosocial rehabilitation plus indistinguishable placebo (placebo group).

Main outcome measures: The main outcome measure was the percentage of cocaine-using days. Secondary measures were the Minnesota Cocaine Craving Scale and 12-Item Short-Form Health Survey scores. Adverse events were reported in both groups.

Results: The study population comprised 54 patients who attended at least one post-baseline assessment, out of the 104 subjects initially enrolled. The mean percentage of cocaine-using days in the homeopathy group was 18.1% (standard deviation (SD): 22.3%), compared to 29.8% (SD: 30.6%) in the placebo group (P < 0.01). Analysis of the Minnesota Cocaine Craving Scale scores showed no between-group differences in the intensity of cravings, but results significantly favored homeopathy over placebo in the proportion of weeks without craving episodes and the patients’ appraisal of treatment efficacy for reduction of cravings. Analysis of 12-Item Short-Form Health Survey scores found no significant differences. Few adverse events were reported: 0.57 adverse events/patient in the homeopathy group compared to 0.69 adverse events/patient in the placebo group (P = 0.41).

Conclusions: A psychosocial rehabilitation setting improved recruitment but was not sufficient to decrease dropout frequency among Brazilian cocaine treatment seekers. Psychosocial rehabilitation plus homeopathic Q-potencies of opium and E. coca were more effective than psychosocial rehabilitation alone in reducing cocaine cravings. Due to high dropout rate and risk of bias, further research is required to confirm our findings, with specific focus on strategies to increase patient retention.

This study can hardly be said to show convincing evidence for homeopathy.

This paper is all the more surprising if we consider the affiliations of the authors:

• Clinical Research Unit (H), Aizawl under Central Council for Research in Homoeopathy, Ministry of AYUSH, Govt. of India, India.
• All India Institute of Ayurveda, New Delhi, India.
• Department of Materia Medica, Madhav Homoeopathic Medical College and Hospital, Madhav Hills,
  Opposite Banas River, Abu Road, Rajasthan, India.

It is time, I think, that Indian officials and researchers learn some critical thinking and formulate the conclusions of reviews based on the evidence they produced. This would be a start:

Our review has not generated convincing evidence to suggest that homeopathy is effective in treating SUDs.