“We were so furious when that happened,” said Buckhalter who, looking back, sees it as his first silver lining to get sober. “We lost our connection, but it started the trickle-down effect of me getting help for the first time. The seed was planted.”
That was over a decade ago. That seed has now sprouted in the form of a device implanted in Buckhalter’s brain. He’s the first person in the United States to undergo deep brain stimulation for drug addiction, a procedure performed at the West Virginia University Rockefeller Neuroscience Institute.
Hooked
On Jan. 8, 2020, during a visit to the RNI, Buckhalter acknowledged it was his 100th day sober — the longest he’d been clean since a prescription for a high school sports injury veered a promising future off track for repeated crash and burns.
Buckhalter, 33, of Dilliner, Pa., was 15 when he dislocated a shoulder playing football. A doctor prescribed Percocet to quell the pain.
“I was off to the races,” he said. “Once I felt what that Percocet could do for me, I knew I wanted that feeling every day.”
Percocet is a combination of opioid narcotic oxycodone and acetaminophen. Oxycodone taps into the brain and central nervous system to relieve pain, and can easily lead to mental and physical dependence. It happened to Buckhalter.
“I hid it well from my family,” he said. “They thought I was just very depressed. To be honest with you, I didn’t know what was happening or understood my addiction at the time.”
Still, Buckhalter managed to excel at sports and said he even could have gained scholarships to play at WVU. However, his grades weren’t up to par, due to his drug abuse.
Percocet led to oxycodone, which led to heroin.
Achieving a high was no longer a goal. Buckhalter needed a fix to function.
The grueling demands of working in coal mines after high school enabled Buckhalter to rely more on pain pills.
“I had a lot of anxiety, so I had to use to not feel the way I was feeling,” Buckhalter said. “Over a 17-year span, I used because I had to. Not because I wanted to. I had to, to not feel sick and just to function as a normal person.”
Gerod Buckhalter shares a moment with his parents, Regina and Rex Buckhalter, before his procedure at WVU Medicine’s J.W. Ruby Memorial Hospital Nov. 1, 2019.
Rock Bottoms and a Last Resort
Buckhalter drifted in and out rehab, spent nights in the emergency room and tried various medications — from Suboxone to Xanax — to escape the clutch of addiction. Nothing worked. Xanax only led to him desiring that anti-anxiety med as another drug of choice. “There were lots of rock bottoms. When I would get clean, I would feel so horrible and feel the need to use again,” said Buckhalter, who compared withdrawal to “having the flu times 100.”
The trajectory of his struggles began to shift a couple of years ago after he sought treatment at WVU, he said.
Buckhalter enrolled into the Comprehensive Opioid Addiction Treatment program, or COAT, a group-based treatment for patients recovering from opioid use. In addition to social support sessions, COAT consists of medication-assisted treatment and access to therapists, psychologists and psychiatrists. Since 2005, more than 2,000 patients, averaging 33 months in treatment, have benefited from COAT.
“Gerod was in one of my group therapies and he really struck me as insightful and dedicated to the program,” said Dr. James Mahoney, assistant professor and clinical neuropsychologist, WVU School of Medicine.
Mahoney knew of a groundbreaking clinical trial he and his colleagues at RNI were about to undertake, a first-of-its-kind in the U.S. It was a procedure that would use deep brain stimulation, or DBS, to aid patients suffering from treatment-resistant opioid use disorder.
Mahoney pegged Buckhalter as a perfect candidate.
“Patient selection is critical,” Mahoney said. “It’s a very invasive procedure, so we look for people who are otherwise healthy and have a strong social support group, like family who will be there through thick and thin.”
Though Buckhalter had reached the end of the line — he’d never stayed sober for more than three months — he wasn’t sold on doctors digging around his brain to implant a device.
Reborn
Previously, DBS has helped patients with Parkinson’s disease, movement disorders and depression. This was the first time it’d been approved to treat drug addiction.
For this clinical trial, funded by the National Institute on Drug Abuse, a team led by Dr. Ali Rezai, executive chair of the RNI, would implant a Medtronic DBS device in the addiction and reward center of the brain, the nucleus accumbens, and a battery under the collarbone.
This would allow the team to remotely monitor brain activity and adjust the device accordingly to respond to the patient’s cravings.
“Basically, it’s a pacemaker in the brain,” Rezai said. “The goal is to reduce the cravings so that people can be in charge of their addiction rather than the addiction being in charge of them.”
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Years of drug abuse alters dopamine levels, Mahoney said. Dopamine is a naturally-produced chemical released by the brain that plays a role in pleasure and satisfaction.
“When you use substances, dopamine floods into the nucleus accumbens,” he said. “Over time, the dopamine levels don’t go up quite as high. It actually dips below the normal baseline. Eventually, you’re so far down that you’re trying to reach back to that baseline level.” The implanted device can stimulate the part of the brain that produces dopamine if levels are too low.
“I think anybody would be a little hesitant (about the procedure),” Buckhalter said. “After weeks of talking it over with my family and girlfriend, I decided to do it. I signed a consent form … before I called a few days later and said, ‘I don’t want to do it.’ It went back and forth a few times and, ultimately, I did it. One reason was Dr. Rezai. I learned about his track record and it speaks for itself.”
Rezai, known for his innovative use of brain implants to treat Parkinson’s, obsessive-compulsive disorder, Alzheimer’s and traumatic brain injury, arrived at WVU in 2017 to head the RNI. At The Ohio State University in 2014, he led a team that restored limb movement for a paralyzed man via chip implant.
“It’s not just me,” Rezai said. “There’s a large, comprehensive team of talent here. It was a very complex procedure.
“West Virginia is a state that’s most affected by the opioid crisis. It’s important that we come up with innovative solutions to be a world leader in advancing the science of how to manage and treat opioid addiction.
“Gerod met our criteria and became the first person in the country to get this implant. He’s a wonderful young man who wants to live better and hopefully we can move him away from his addiction and dependence. He’s got a very bright future.”
A few months post-surgery, Buckhalter said there’s a remarkable difference in how he feels. Cravings are less frequent, though doctors have made a few adjustments to his stimulator.
He’s continued his other treatments at WVU while his team monitors his progress. He’s taking this renewed life one step at a time.
The RNI isn’t done, either. Three more patients will be selected to undergo the procedure.
“I’ve had a few ups and downs, but for 90 percent of the time, I’ve felt very good,” Buckhalter said. “I have no desire to use. Before, I didn’t do anything because nothing brought joy to my life. But now I feel like I am simply enjoying everyday living.”
WVU Medicine’s Dr. Ali Rezai, executive chair of the WVU Rockefeller Neuroscience Institute, confers with his staff during Buckhalter’s surgery.
Deep brain stimulation: Implantation of tiny electrodes into a specific brain area.
“We are tackling opioid addiction in a very coordinated fashion,” Rezai said. “Whether it’s taking preventative measures, like using micropellets or wearable technologies, or treating severe addiction with DBS, ultrasound or magnetic waves, these are among the most innovative programs in the world, and it’s happening right here in Morgantown, West Virginia.”
5 Prongs of Innovation
1. Deep brain stimulation
With Gerod Buckhalter being the first patient, the RNI will implant the Medtronic DBS device in three others. Supported and funded by the National Institute on Drug Abuse, DBS acts as a brain pacemaker that modulates the reward center of the brain.
2. Focused ultrasound
The RNI is just one of five sites in the U.S. that utilizes magnetic resonance-focused ultrasound — an FDA-approved treatment for tremor and Parkinson’s disease that requires no exposure to radiation. Now, Rezai said, the RNI will test the ultrasound on patients suffering from opioid addiction. This is an FDA first-in-the-world clinical trial. Focused ultrasound uses non-audible sound waves that can potentially reduce abnormal activity in the brain.
3. Transcranial magnetic stimulation
Magnetic fields — via an electromagnet — can be used to stimulate nerve cells and areas of the brain involved in behavioral self-control and regulation, Rezai said. This technology is FDA-approved for treating severe depression and obsessive-compulsive disorder.
* “These first three technologies are for patients who have tried medications, intervention and various therapies but are not improving,” Rezai said. “We’re among the first in the world taking these approaches to addiction treatment.”
4. Micropellets
A clonidine micropellet is half the size of a grain of rice and placed in a patient’s lower back to combat pain. The pellet would slowly dissolve over time, delivering non-opioid pain medication to nerve cells, minimizing the need for pills. Targeted therapy for chronic pain would stop addiction at the root, Rezai said.
5. Wearable technologies
The RNI has all kinds of wearable gadgets, from wedding band-like rings to wristwatches and even clothing, that constantly monitor a person’s vitals and collect health data. By applying artificial intelligence and machine-learning to the data collected, the RNI team can better predict behavior and cravings of patients, particularly those addicted, Rezai said. There are currently 70 people using wearable technology that the RNI is monitoring.