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Tom Warburton

Naloxone: the opioid overdose reversal drug

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Naloxone: the opioid overdose reversal drug

Get a free naloxone kit and training

If you would like a naloxone kit please visit your local service along with training on the prevention and management of opioid overdose. Training can take as little as 10 minutes.

Naloxone can be supplied to anyone at risk of opioid overdose, as well as their friends and family.

What is naloxone?

Naloxone is a drug that can reverse the effects of opioids, and prevent death if used within a short period following an opioid overdose. For many years, naloxone has been used within emergency medical settings to reverse the effects of an opioid overdose and prevent death. In short, naloxone saves lives.
Naloxone is only effective on opioids, such as heroin, methadone, morphine, codeine, buprenorphine, opium, and pethidine.

How does naloxone work?

Naloxone is an opioid antagonist – this means it can temporarily remove opioids from the receptors in the body and prevent the opioids from re-attaching to the receptors for a limited period of time.
Naloxone can rapidly reverse a reduced breathing rate (known as respiratory depression) when caused by an overdose of opioids. Naloxone takes 2-5 minutes to have an effect when injected into a muscle. The effects last for about 20 minutes. This means the use of naloxone can buy critical time while waiting for an ambulance to arrive.
Naloxone can be supplied by:
“Persons employed or engaged in the provision of drug treatment services provided by, on behalf of or under arrangements made by one of the following bodies–
(a) an NHS body
(b) a local authority
(c) Public Health England
(d) Public Health Agency
Naloxone can be supplied to anyone at risk of opioid overdose, as well as their friends, family or other representatives.
Before supplying naloxone to anyone, we provide training on how to recognise opioid overdose, overdose management, and the use of naloxone injection.

PLEASE NOTE: naloxone should never be considered as a safety net to take extra risks.

Naloxone can be supplied to anyone at risk of opioid overdose.

How to recognise when someone has overdosed

Symptoms can include:

• Deep snoring/‘gurgling’ noises
• You cannot wake the person, and they are not responsive to shouting or shaking of the shoulders
• A blue tinge to lips, nail beds or other extremities
• Not breathing

Key steps to remember

• Ensure personal safety first
• Call 999 and ask for an ambulance
• Check that nothing is obstructing their airways
• Place the person in the recovery position
• Inject naloxone into the thigh or upper arm muscle
• Wait with the victim until the ambulance arrives and safely dispose of the naloxone kit to paramedics
If someone has had an opioid overdose, naloxone will buy precious time. The individual still needs to go to hospital. Always dial 999 for an ambulance.

These tips apply to people who have a naloxone kit and have previously received full training. Look on-line to read the Prenoxad Injection patient information leaflet.

How to get a replacement naloxone kit

When you need a replacement kit due to the current dose being used, lost, damaged, or out of date, you should ideally return to the change, grow live service where you were originally trained and given the naloxone kit. We can then provide you with a new one if required. If the change, grow, live service where you originally received your naloxone kit is now closed, you can visit another change, grow, live service – find your nearest one. You can also find a full list of drug services (including other providers) on the Talk to Frank website.
Return to the same service to get another naloxone kit

Ear Acupuncture for the Masses (By Ryan Bemis)

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Ear Acupuncture for the Masses

Acupuncture is becoming more accessible—one ear at a time.
Ear acupuncture, also known as auricular acupuncture, is the most widely used form of acupuncture within Western health settings in the United States and Europe.
This is due in part to the fact that some ear acupuncture protocols can be performed by non-acupuncturists. Standardized ear protocols are safely taught to existing healthcare workers who can easily integrate them as part of their clinical practice within hospitals, and mental health and addiction clinics. In the military, personnel are trained in ear acupuncture protocols to address pain and trauma symptoms in soldiers.
Perhaps the most established model of ear acupuncture today is a protocol known as NADA.

What Is NADA and What Is It Used For?

NADA stands for National Acupuncture Detoxification Association. This is a non-profit organization that was established to support the uptake of the ear acupuncture protocol that now bears its name.
The protocol itself was created back in the 1970s, by a psychiatrist named Michael Smith, at Lincoln Hospital in the Bronx section of New York City. Smith, alongside other physicians and community activists, modified an ear protocol used in China for pain relief and opiate withdrawal to develop the NADA protocol.
The NADA model of care originally was designed to aid the detox process for heroin and methadone addicts. But over the past three decades, the five-point protocol has been adapted for use in a variety of community health settings. In addition to aiding addiction recovery, the NADA protocol is used to support smoking cessation, weight loss, and generalized stress and anxiety. Psychiatric programs use the NADA protocol to help people who are coming off medications.

Why Those Five Points?

The NADA protocol—also sometimes referred to as the “acu detox” protocol—consists of five acupuncture points in each ear: Shen Men, Sympathetic, Kidney, Liver and Lung.
The Shen Men and Sympathetic points calm the recipient. The Kidney point addresses fear. Liver detoxifies and unblocks stuck energy, be it emotional or physical. Finally, the Lung point helps people let go.
As a protocol, this combination of points is a superb de-stressor for almost any individual. But as a model, NADA has an even greater impact because it empowers communities. Since these five points can be safely taught to local personnel, providers are able to directly influence the health and wellness of their own communities. For example, there are thousands of NADA-trained community workers in the New York area. After the recent Hurricane Sandy, these providers have been able to offer treatments to traumatized citizens and other relief workers.
NADA is a cost-effective—less than 50 cents for five needles in each ear—and drug-free method of healing for the masses.

Did You Say That Non-Acupuncturists Can Give People NADA?

Yes. In a clinic, hospital or community centre, the person administering the NADA protocol is not necessarily a licensed acupuncturist. He or she might be a therapist, nurse, drug counsellor or other community worker who took NADA’s training course.
Since the founding of the NADA organization in 1985, over 25,000 people throughout the world have been trained to perform the NADA protocol. Clinics offering the protocol exist today in over 40 countries. In the United Kingdom, nearly 90 percent of prisons offer the NADA protocol to inmates as a method of reducing violence.

Do Acupuncturists Also Perform NADA?

Many licensed acupuncturists use the NADA protocol in their private practices. Sometimes a person comes for acupuncture feeling very stressed. The NADA protocol often is the first thing an acupuncturist will do to help that person calm down.
Acupuncturists also use the technique when working in disaster-relief or recovery settings, in places where performing an intake and thorough diagnosis is impractical or culturally inappropriate. NADA Registered Trainers—the people who train non-acupuncturists on how to perform NADA—are licensed acupuncturists as well.

What Is a Typical NADA Treatment Like?

The NADA protocol requires no diagnosis for effective treatment. Unlike a private acupuncture session, where the practitioner spends a lot of one-on-one time with the patient, the NADA protocol is performed quickly, in a group setting.
A group receiving NADA treatments sits in silence while the practitioner walks around the room inserting the same five points into each person’s two ears. There is often a calming, almost meditative energy in these settings. The quiet group experience can be a profound addition to recovery programs, where talk therapies are emphasized.
In some health settings, the NADA protocol is available for anyone seeking help, regardless of his or her ability to pay. Many acupuncture clinics offer ear acupuncture treatments at a lower rate than full-body treatments.

How Can I Get NADA Training or NADA Acudetox Treatments in the UK?

If you are interested in NADA Acudetox 5-point protocols training, please contact us on below details.


Tel: Training: 07754 811254 (Steve Pinnington)
Admin: 07514 780165 (Tom Warburton)



Ryan Bemis works as an acupuncturist, NADA trainer and NADA supervisor in the U.S./Mexican border region. He is founder of Crossroads Community Acupuncture in Las Cruces, New Mexico and the NADA Border Project in Ciudad Juarez, Mexico. He is also a contributing writer and
editor for Guide points, NADA’s bimonthly publication.

The History of the NADA 5-point Acupuncture Protocol

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                 The History of the NADA 5-point Acupuncture Protocol

The National Acupuncture Detoxification Association (NADA) is a not-for-profit training and advocacy organisation, encouraging community wellness through the use of a standardised auricular acupuncture protocol for behavioural health, including addictions, mental health and emotional trauma. We work to improve access and effectiveness of care through promoting policies and practice which integrate the NADA protocol with other western behavioural health modalities.

History of NADA

The use of acupuncture is a major component of the ancient traditional art of Chinese medicine. Chinese cultures have placed needles into precise locations on the body to relieve pain and treat disease for over 2000 years. Acupuncture for the treatment of addiction is a recent development in the history of this ancient art.


In 1973 a Chinese doctor, Dr H L Wen, a neurosurgeon working in Kwong Wah Hospital in Hong Kong was the first to report successful treatment of withdrawal symptoms and cravings of addiction with acupuncture.  Dr Wen observed that opiate users who had undergone surgery and received acupuncture for post-operative pain relief experienced fewer withdrawal symptoms and cravings.  He subsequently conducted clinical studies that established acupuncture as a valuable treatment for other forms of addiction, and published his findings in the “Asian Journal of Acupuncture”.

Meanwhile, over in mid-seventies USA, the New York Bronx had a growing epidemic of drug addiction and, in response to local outrage, the Lincoln Recovery Centre emerged.

Initially, the Lincoln was a methadone prescribing program but many of the staff had concerns about the use of addictive drugs to treat substance abuse.  Staff became interested in the acupuncture treatment method after learning of Dr Wen’s success with heroin addiction, and the addition of acupuncture for detox to the recovery program began in the late 1970s.

The staff, who donated their own time to this pioneering project, sought acupuncturists that would be willing to attend the Lincoln to demonstrate acupuncture; they started with the protocol used at Kwong Wah Hospital, which was to needle the Lung point on the Ear and add electro-stimulation, with the effect lasting for around six hours.

Because of a problem of the electro-stimulator boxes constantly breaking, staff discovered, much to their surprise, that the non-electrical potentiated treatment (Inserting needles by hand) had a more prolonged effect.

This development led to affect the proliferation of NADA’s acupuncture treatments.  They found that using plain needling (Without Stimulation) was more effective, more flexible and less expensive, thus making the treatment more accessible. The practice was easier to learn and easily replicated.

Once the efficacy of acupuncture was firmly established, many of the Lincoln staff, including Dr Mike Smith (pictured below), went on to study acupuncture and, over time and with much experimentation of various ear and body points, the current NADA 5-point protocol was embraced.

The protocol involves the gentle placement of up to five small sterilised disposable needles into specific sites on each ear; no electrical stimulation is used.  The recipients sit quietly in a groups setting for between 40–45 minutes, relaxing or meditating.

NADA Acudetox treatments have been shown to reduce the impact of withdrawal symptoms from alcohol, opiates, cocaine and amphetamines.  It also diminishes the cravings associated with some of the most commonly abused substances, including nicotine and prescription medication.

Incorporated in 1985 in the state of New York, the National Acupuncture Detoxification Association (NADA US) was established by Dr Michael Smith, Director of the Lincoln Recovery Centre, along with other like-minded people.  Their aim was to promote education and training of substance misuse counsellors in the NADA 5-point protocols.

Having determined the need to expand training capacity and awareness of auricular acupuncture as an effective tool for recovery, their work has gone on to help spread the use of standardised NADA acudetox protocols and practices both nationally and internationally.


NADA established membership enrolment, a collection of related reference materials, a codified training curriculum, and flexible systems for registering qualified trainers and methods for delivering training.


NADA has since trained thousands of health professionals, including counsellors, social workers, nurses, medical doctors, psychologists, acupuncturists, chiropractors, out-reach workers, drug court workers, corrections officers and many others, in the use the NADA 5-point Protocols.

Understanding the principles of both Chinese medicine and substance misuse is basic to NADA training and philosophy; the combined application of acupuncture alongside counselling and self-help groups enhances opportunities for success.

NADA in the UK


In 1991, the NADA 5-point Protocols were introduced and set-up in the UK by John Tindall at the Gateway Clinic, London.  John began to train health workers in the field of addiction and mental health in the NADA 5-point Protocol, including to prison officers and NHS staff.

In the mid-1990s NADA UK was established, in 2005 NADA UK became a registered charity with its own board of trustees.  Unfortunately, due to unforeseen problems with the board of trustees, in 2014, NADA UK had to take a different direction.

NADA was taken over by Steve Pinnington, who was for many years, a NADA trustee and integral part of the NADA UK board, as well as a NADA registered trainer.  He was trained by John Tindall in the early 1990s and went on to study full body Acupuncture and Pharmacology at The Beijing University of Chinese Medicine, London.

In 1998, Steve Pinnington established NADA Acudetox Training Workshops as the major NADA training body for the UK.  He also went on to introduce NADA Acudetox to Scotland and in 2014 established NADA Scotland.  NADA Acudetox and NADA Scotland have now become the major training body in the UK for NADA Acudetox 5-Point Protocols training.

NADA Worldwide


NADA protocols are now used in over 40 countries around the world as a legitimate tool for addiction and associated mental health problems.

NADA 5-point Protocols are being used in many countries around the world:

Austria       Denmark      Greece      India Foundation      South Africa      Norway      Japan

Finland      Germany      Philippines      Ireland      Sweden      Tunisia      Bermuda      Canada

Chile      Bhutan      Columbia      Guatemala      Croatia      Scotland      Greenland      Haiti

USA    Iran      Singapore      Italy      Israel      Russia      Kenya      Hungary      Nepal      Romania

Peru      Thailand      Trinidad & Tobago      Uzbekistan      Ecuador      United Kingdom

Mexico      Australia      New Zealand     Uganda

NADA Acudetox Protocols are also being used in some Asian countries to help people cope with the aftermath of natural disasters. NADA Acudetox Protocols were also used to treat New York Fire Fighters and Police Officers dealing with PTSD following the 9/11 attacks in the USA.

NADA Acudetox treatment programs are clinically effective, cost efficient, drug free and compatible across cultures.  Acudetox is also, non-verbal, non-threatening, and a first stop intervention that has a calming effect on clients.  As an initial form of substance misuse therapy, it has been shown to improve clients’ overall treatment response and retention in the program.

A 1999 CSAT-funded study showed that patients choosing outpatient programs with acupuncture were less likely to relapse in the 6 months following discharge.

(Shwartz et al. 1999)

Scotland, the highest drug death rate in the EU

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Scotland, the highest drug death rate in the EU

BBC News 16 July 2019

The number of drug-related deaths in Scotland soared to 1,187 last year, according to official statistics.

The figure is 27% higher than the previous year, and the highest since records began in 1996.
It means there were more drug-related deaths in Scotland last year than the 1,136 alcohol-specific deaths.

And the country’s drug death rate is now nearly three times that of the UK as a whole, and is higher than that reported for any other EU country.

The latest figures also mean Scotland has a higher drug death rate than the one reported for the US, which was previously thought to be the highest rate in the world.
There were more than 70,000 drug deaths in the US in 2017 but the rate of 217 per million of the population is now marginally lower than Scotland’s rate (218).
There were 3,756 deaths relating to drug poisoning in England and Wales in 2017, a rate of 66 deaths per million. The rate in Northern Ireland is about 75 per million, with 136 deaths in 2017.
However, countries differ in how deaths are recorded, and there may be under-reporting in some cases.

What do the Scottish figures show?

The statistics published by National Records of Scotland show that nearly three quarters – 72% – of those who died last year were male.
The vast majority of drug-related deaths – 1,021 – involved heroin, but a large percentage – 792 – had also taken pills such as diazepam and etizolam.

The 35-44 age group was associated with the most deaths at 442, followed by those aged 45-54 (345).
The Greater Glasgow and Clyde health board area had the highest number of deaths at 394, followed by Lothian (152), Lanarkshire (130) and Tayside (109).
But the report said that the problem was “clearly very widespread” across the whole country.

Why does Scotland have so many drug deaths?

There are said to be about 60,000 problem drug users in Scotland, which has a population of 5.4 million people.
Dr Saket Priyadarshi, of NHS Greater Glasgow and Clyde addiction services, told MPs last week that Scotland had a much higher drug death rate than the rest of the UK because it had far more problem users.
He also said that Scottish users were taking a lethal cocktail of drugs that often combined opiates such as heroin and methadone with benzodiazepines, pills often known as street valium or street blues.
Dr Priyadarshi said there was an ageing population of drug addicts, mainly men, who had been using heroin for decades and were now also taking new street pills, often containing etizolam which is stronger than prescription benzos.
Earlier this month, The Daily Record newspaper launched a campaign calling for the decriminalisation of drug use.
It said Germany, Spain, Switzerland, Canada and, most notably, Portugal were among 25 nations to loosen the punitive attitude to drug possession to enable treatment programmes to succeed.

‘I lost my mum, dad, two sisters and brother to drugs’

Jacquie, from Glenrothes in Fife, has told how her father, mother, two sisters and brother all died because of drugs.
She said losing her parents and siblings “was like a fire ripping through my family”.
Jacquie, 34, is herself a recovering drug addict.
She told BBC Scotland’s The Nine: “It is scary how quick it can take a grip and devastate a family.
“I feel my life has been ruined.
“People could say that has been my fault, I understand that with the drug side. I can’t help the fact that I have lost all my family to the drugs. And it is hard.”
Jacquie, who began taking heroin at the age of 17 and is now trying to kick the habit, said she could not remember a time when the family wasn’t affected by drugs.
She is the last remaining member of her immediate family – who all lived and died in the Fife town of Glenrothes.

‘Bold move’

Scottish Public Health Minister Joe Fitzpatrick said the number of people who have lost their lives because of drug use was “shocking” and it was time for drug abuse to be treated as a public health issue.
During evidence to MPs at Westminster last week, Mr Fitzpatrick praised the “bold move” taken in Portugal to decriminalise drugs but said his government in Scotland was unable to make changes as drugs policy was reserved to Westminster.
But he has pledged to give consideration to any proposals that are brought forward by a new drugs taskforce set up by the Scottish government to examine how best to tackle the issue and save lives.
The woman leading the taskforce, Prof Catriona Matheson, told BBC Scotland the evidence for decriminalisation was strong.
She said: “It is about not putting these marginalised drug users into prison because that further marginalises them and that makes the recovery all the more difficult.”

Denmark is among the countries to have introduced fix rooms, where people can inject themselves with Glasgow City Council’s plan for users to be able to take their own drugs under the supervision of medical staff at a special facility in the city would also need a change in UK law.
The Home Office has refused permission for Glasgow to set up the so-called “fix rooms”, where users could inject heroin or cocaine in a safe and clean environment.
It was hoped the special room would encourage addicts into treatment, cut down on heroin needles on city streets and counter the spread of diseases such as HIV.

Why addicts take drugs in ‘fix rooms’

The Scottish Conservatives said the SNP has had sole control over Scotland’s health and justice systems for 12 years, but has “only worsened the drugs crisis” in that time.
Tory MSP Annie Wells claimed the Scottish government was “pinning their hopes on consumption rooms, because they know it’s something the UK government does not agree with”.
She added: “They should be focusing their efforts on rehabilitation and abstinence-based recovery, the very services they have cut to the bone.
“Over the last decade, the Scottish government’s approach has been to park vulnerable users on methadone. Yet these figures show methadone now causes even more deaths than heroin”.
Meanwhile, Scottish Labour said the Scottish government has cut funding for Alcohol and Drug Partnerships by 6.3% since 2014/15.

Can Alcoholism be treated with Acupuncture

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Can Alcoholism be treated with Acupuncture

An old proverb says “First, the man takes a drink; then the drink takes a drink; then the drink takes the man.” I was that man and with the help of acupuncture, I am taking back my life.
I have “enjoyed” what I believe to be reasonable success after 21 sessions within a four week period in December with a weekly follow-up of one session per week ever since. My alcoholic compulsion is markedly reduced with the side benefit of elevated vigour and more energy from day to day.
Plus, I have had relief from the usual pain I experience from arthritis caused by degenerative cartilage in both knees – pretty severe condition, too, as I have entertained having replacement surgery before this recent development of relief from pain by acupuncture treatments.
Hence, I have become somewhat of a new disciple of acupuncture with zeal to learn more – especially with regard to the success had by some in tempering alcoholic compulsion. I believe it is particularly effective to the recovering alcoholic who is relapse prone who has made conscientious and earnest effort in trying to recover but continues to succumb to whatever forces cause him/her to pick up that first drink again.
Of course, I have no inner personal assurance to myself that I will not be weak again, but I believe if I continue to do the usual and simple things suggested by AA, I feel I can expect a less trying recovery with my newly affected condition that I attribute to the acupuncture treatments.
I literally do not have the compulsion or craving. An occasional thought of drinking passes by with no pangs or lingering thoughts. It just passes by as if by providence – I prefer to think this, too, is responsible for my relief. Maybe my final surrender to the disease was, in fact, the real need met. Going for such a radical (by Western standards) course of action – acupuncture – I may have become treatable. Nevertheless, I cannot deny the most compelling awareness of all of this being the result of the treatments regardless of how non-conforming it may be by the usual standard of Western culture/medicine practice.
I’m not just “some old convert” who’s newly sober – I’m an old drunk who’s found a new tool to help me stay sober one day at a time! With temperate judgment of the use of acupuncture as an ancillary to AA’s twelve-step program, it really seems to help guard against PAWS – it almost seems to remove them. PAWS means “Post Acute Withdrawal Syndrome.” which includes:
1. inability to think clearly
2. emotional over reactions
3. memory problems
4. sleep disturbances
5. physical coordination problems
6. problems in managing stress
I recently read about a doctor who said that the only necessary proof of acupuncture’s worth was the very fact that IT WORKED. Period. Not that one should expect scientific rationale or “western” methodology. No. It just works. Not in every case, but neither do western solutions (cures) always answer their call. So? If it works, use it – enjoy – heal. Accept. I did, and I continue to do so… One day at a time.

My Experience Using Acupuncture to Treat Addiction (BY MARGARITA ALCANTARA)

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My Experience Using Acupuncture to Treat Addiction
APRIL 20, 2013 7:10 AM EDT

Even before I became a Licensed Acupuncturist and Reiki Master I believed in the powerful energy medicine of acupuncture and Reiki. I always knew I loved medicine and healing, ever since I started reading my father’s medical texts in his library at a young age (he’s a retired radiologist). During regular trips to the Philippines throughout my childhood, I became familiar with the existence, relevance, and interconnectedness of Western medicine and traditional or indigenous forms of healing.

My path eventually led me to what I love to do — learn how to help heal the physical body by healing the spirit and emotions, and vice versa. Because they’re totally connected!

One experience that brought this concept home for me was when I worked at a harm reduction agency in the Bronx, in what was called “The Sanctuary.” I provided an Ear Acupuncture protocol called NADA (National Acupuncture Detoxification Association). NADA refers to the five-point Ear Acupuncture protocol for recovery from addictions, particularly addiction to drugs, alcohol, nicotine, caffeine and even hunger cravings.

Not only does this system reduce the cravings, anxiety, sleep disturbance, and need for pharmaceuticals, but it helps create a more optimistic and synergistic attitude towards the process of recovery, and has been reported to improve program retention.
It essentially reboots the sympathetic nervous system, that “fight or flight” response that can get out of hand, causing us to experience escalating anxiety and heightened stress. In fact, because of its track record, the particular program I was running at the agency was funded by Substance Abuse and Mental Health Services Administration, or SAMHSA.

Each time I entered The Sanctuary and set up for the day — laying out the filiform, sterilized, one-time use stainless steel needle packets, alcohol swabs, turning on a relaxing music CD on the boom box, fixing the chairs and prepping the treatment tables and lighting some incense — I knew I was creating a safe space for everyone who entered. Sometimes I was also there to maintain the peace, since I served a lively bunch! They were all at different stages of recovery, and I met them wherever they were at the time they entered. Sometimes they wanted to chat, and I got to know some of their lives well.

So, with a smile and my hand pointed towards the nearest empty seat, I’d welcome them. I rarely saw women in The Sanctuary, but when I did, I had a sense that they appreciated being treated by a female. As I soon learned, many of these women had experienced much in life — sexual abuse during childhood and going into adulthood, physical abuse in general, jail, homelessness, selling their bodies to get their next hit, being prohibited from seeing their children, trials experienced in the court system, and dealing with diseases such as HIV/AIDS and Hepatitis C.

Aside from simply providing acupuncture and Reiki, it was important to me to connect with them while keeping my strength intact. Sure, by getting a voucher from me at the end of their treatment they were able to redeem it for a delicious authentic lunch in the kitchen, but I think they also enjoyed taking that one moment out of their day just to obtain a sense of serenity. Many of them took naps during their treatment, often they hung out past the typical 15 minutes that ear needles are left in for. And, despite the disruptions that sometimes occurred, most left The Sanctuary feeling much more relaxed and calm. When they nodded their head at me with a sincere word of thanks, along with a sparkle in their eye that they didn’t have when they first came in (we Chinese Medicine practitioners call that Qi), I could tell that their Shen/Spirit was back home.

Although I no longer work at the harm reduction agency, I am still floored by the physical and emotional healing impact of acupuncture and Reiki on those recovering from addiction. True, it was a job I was being paid to do, but it was an absolutely priceless opportunity to be able to connect on a heart level with the community. It was actually I who felt enriched!

Evidence for the NADA Ear Acupuncture Protocol

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The National Acupuncture Detoxification Association (NADA) ear acupuncture protocol, originally developed for addiction treatment, has been adopted as a complementary therapy within a variety of community health settings. This review first offers an introduction to the NADA protocol, including its origins, development and its adjunctive application as a comprehensive model of care. Second, a review of evidence is offered on the use of the NADA protocol within addictions, behavioral health and cancer care.


The National Acupuncture Detoxification Association (NADA) ear acupuncture protocol utilizes up to five ear points–shen men, sympathetic, kidney, liver, and lung. Based on acupuncture analgesia research in Hong Kong (Wen & Cheng, 1973), this protocol was developed in the mid 1970’s at Lincoln Hospital in the South Bronx, NY by physicians including Omura, Taft and Smith (Mitchell, 1995). The NADA protocol has since been incorporated within a variety of health care and self-help settings around the world. The technique is variously referred to in existing literature as acupuncture detoxification, acu detox, NADA acupuncture, the three-point protocol, the five-point protocol, five-needle protocol, 5NP, the SMART protocol, and Auricular Acupuncture (abbreviated AA). It is also commonly referenced as “community acupuncture,” “acupuncture” and “auriculotherapy.” For the purposes of this summary it will be referred to as the NADA protocol.
The NADA protocol is ideally offered as a part of a comprehensive model of care. Developed at Lincoln Hospital, the approach is known as the NADA model (see p.6), which includes several
components that made it an effective and economical system of care (Smith, 2010). The model recognizes that not one single component of a comprehensive recovery or health program can be seen as a “cure” or “stand-alone” therapy for any condition. This assumption poses a challenge for researchers to isolate and determine the efficacy of the NADA protocol. As recent US Department of Justice and British Medical Journal publications have noted, the NADA protocol is best utilized as a component, not as an isolated function within community health programs (American University School of Public Affairs Justice Programs
Office, 2011, Cowan, 2011). Future research should take this into consideration.
The NADA US organization, established in 1985 to provide training and education in the technique, estimates today that over 25,000 providers worldwide have been trained in the procedure. Projects that offer the NADA protocol exist today in over 40 countries (National Acupuncture Detoxification Association, 2013). The settings in which the NADA model has been integrated include addictions, psychiatric/mental health, prisons, disaster relief, Native American reservations, refugee settings, pastoral care, humanitarian aid, sickle cell, cancer and HIV/ADS care. This summary covers three areas: addictions, community health and cancer/blood disorders.

Review of literature on the NADA protocol for community health

The following sections offer a review of current research, outcomes, prevalence and pilot data on the use of the NADA protocol as a community health adjunctive therapy, including addictions treatment, behavioral health and cancer care.


The prevalence and appropriateness of acupuncture for addictions is well established. The US federal government’s Center for Substance Abuse Treatment (2007), the United Nations (2006), the State of New Mexico (Bigelow, 2008), as well as the US Department of Defense/ Veteran’s Affairs (2010) have each published best practice guidelines that address the value of acupuncture for chemical dependency.
Federal statistics (SAMHSA, 2000) show that over 500 addictions programs in the US use some form of acupuncture. A more recent estimate by Reuben et al. (2005) determined that at least 1500 addictions programs worldwide use some form of acupuncture for addictions. In Denmark, the NADA protocol is one of the most prevalent forms of Complementary and Alternative Medicine modalities used within rehabilitation programs (Skovgaard, la Cour, & Kristensen 2012).
The evidence base for the adjunctive use of the NADA protocol for addictions continues to grow. Studies published in peer-reviewed journals support the adjunctive use of the NADA protocol for heroin, alcohol and cocaine addictions treatment (Bergdahl et al., 2012 Santasiero & Neussle, 2 07, Russell, Sharp and Gilbertson 2000, Avants, Margolin, Holford, & Kosten, 2000, Shwartz, Saitz, Mulvey & Brannigan, 1999, Washburn, et al., 1993, Bullock, Culliton, Olander, 1989, Bullock, Ulmen, Culliton, & Olander, 1987,) as well as nicotine addictions (White, Rampes, Liu, Stead, & Campbell, 2011, Bier, Wilson, Studt, Shakleton, 2002,
Stuyt & Meeker, 2006, He, Medbe, & Hostmark, 2001, He, Berg, & Hostmark, 1997). Recent studies by Chang, Sommers, & Hertz (2010), and Carter, Olshan-Perlmutter, Norton, & Smith (2011) demonstrate that the NADA protocol in addition to standard care is significantly better than standard addictions care alone. One observational study (Janssen, Demores & Whynot 2005) demonstrated the value of the NADA protocol for people with addictions problems within a harm reduction setting.

Behavioural health

The use of ear acupuncture within behavioral health/psychiatric care has expanded in recent years, particularly within US and Indian military units (Niemtzow, 2011, Smith, 2012), European and US prisons and psychiatric hospitals (Smith, Carter, Landgren, & Stuyt, 2011). A national survey in Sweden found that the NADA protocol is widely used in public psy-Acupuncture continues to be accepted within mainstream psychiatric treatment in the US. Yale Medical School has established a NADA training program for psychiatric residents (Bruce, 2011). The Department of Veteran’s Affairs (VA) and the Department of Defense Evidence Based Practice Guidelines (2010) assigns a “good quality” of evidence to support the use of acupuncture to treat post traumatic stress disorder (PTSD), including symptoms of pain, insomnia, depression and addictions issues. Standardized ear protocols are applied for trauma and pain by mainstream military medics in the US (Niemtzow, Litscher, Burns, & Helms, 2009, Niemtzow et al., 2008, Niemtzow, 2011, Belard & Pock, 2011, Helms et al., 2011).
A number of studies support the adjunctive use of the NADA protocol for non-addictions
programs within psychiatric hospital, mental health, and prison settings (Lemaire & Gonzalez,
2011, Payer, Ots, Marktl, Pfeifer, & Lehofer, 2007, Berman, Lundberg, Krook, & Gyllenhammar,
2004, Nixon, Cheng, & Cloutier, 2003, Berman & Lundberg 2002). Carter et al.
(2011), though conducted within an addictions recovery setting, demonstrated how the
NADA protocol alleviates a number of different common health symptoms. Additionally,
several published qualitative reports (Cole & Yarberry, 2011, Yarberry, 2010), program evaluations
(DARE 2011), acupuncture field reports (Dolan & Menolascino, 2010, Sommers & Porter,
2011) and news stories (Kocherga 2012, Scudder, 2012) demonstrate the value of the
NADA protocol as a disaster relief/humanitarian aid intervention for first responders as well
as populations affected by violence and trauma. Preliminary reports on the Military Stress
Recovery Project’s numerous clinics around the US demonstrate that the NADA protocol
can assist veterans with a variety of psychiatric symptoms (Duda Harris, 2012).

Cancer/Blood disorders

The NADA protocol has been used as an adjunctive care and self-help support modality for people with cancer and blood disorders, including sickle cell disease, AIDS/HIV, and cancer. Programs using the NADA protocol have been established in the Sickle Cell Support Group of Atlanta, Quest Center for Integrative Health’s breast cancer and HIV programs in Portland, and the University of South Carolina Medical School. Two recent studies have demonstrated preliminary evidence for the use of the NADA protocol as part of cancer therapy (Valois, Young, Robinson, McCourt, & Maher, 2012, Harding, Harris, & Chadwich, 2008).


The NADA protocol, developed as an addictions therapy, has been adapted into a variety of health care settings worldwide. The protocol is best integrated as a comprehensive model of care. This review of literature substantiates this modality’s continued expansion within addictions and behavioural health treatment, including prisons, military medicine, and disaster relief/humanitarian aid, as well as its use to treat cancer/blood disorders.

Components of the NADA model

Integration within other interventions

These may include a supportive non-confrontational approach to counseling and
medical care; an emphasis on self help, peer mentoring and/or 12 step groups
early in the recovery process.

Barrier free

NADA treatments are offered as a “barrier free” treatment; lengthy assessments
and intake are unnecessary to screen for “appropriate” patients. The NADA clinic
serves as a “front end” to the other services, allowing the client the opportunity
to experience “something significant” prior to committing to a treatment or med-

Regular treatments

Treatment is available without appointment throughout the week, ideally on a
daily basis in early stages of treatment.

Communal setting

NADA treatment is provided in a group setting for a duration of 40-45 minutes.
All clinical activities take place within a tolerant informal family-like atmosphere.

Local personnel and/or cross-trained health providers offer the therapy

Service delivery of the NADA protocol should not be dependent on full body
acupuncturists or physicians. To maximize the cost-effectiveness, the accessibility of
the treatments, and cultural competency, NADA protocol treatments are provided by NADA-trained health workers who already work within the existing community
health program.

Use of toxicologies to monitor progress

When in the context of addictions treatment or pharmaceutical medication detoxification/ tapering, frequent toxicologies are emphasized to monitor progress.

Collaboration with court-agencies

Clinicians have a willingness to work with court-related agencies, including drug
court, mental health court and veteran’s court.

Read the report in full

Evidence for the NADA Ear Acupuncture Protocol