Vanderbilt Integrated Community TMS for Opioid Recovery (VICTORY): Study protocol for a randomized, controlled trial of non-invasive brain stimulation to reduce craving in people with opioid use disorder
This study protocol outlines a randomized, single-blind, sham-controlled trial investigating whether weekly left dorsolateral prefrontal cortex-targeted intermittent theta burst stimulation (iTBS) reduces craving and opioid use while improving treatment retention in individuals with opioid use disorder maintained on buprenorphine, alongside an examination of associated neural mechanisms via neuroimaging.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of a preprint that has not been peer-reviewed. It is not medical advice. Do not make health decisions based on this content. Read full disclaimer
For millions of people, the path to recovery from opioid use disorder is paved with a medication called buprenorphine. This drug is a powerful tool that keeps the body from suffering the agonizing physical symptoms of withdrawal and significantly lowers the risk of fatal overdose. Yet, even when the body is stable and safe, the mind often remains trapped in a cycle of intense desire. This craving is not merely a fleeting thought; it is a powerful, persistent drive that can override logic and lead a person back to using drugs, undoing the progress made by medication. Scientists have long known that this urge is rooted in the brain's wiring, specifically in circuits that link the regions responsible for decision-making with those that process reward and habit. In recent years, researchers have begun exploring a non-invasive way to gently reshape these circuits using magnetic pulses, a technique known as transcranial magnetic stimulation, or TMS. While this method has already helped people with depression and smoking addiction, its potential to quiet the specific, overwhelming cravings of opioid use disorder remains a question waiting to be answered.
The VICTORY study, led by researchers at Vanderbilt University Medical Center and a private clinic in Tennessee, sets out to test whether a specific pattern of these magnetic pulses can help people stay on the path of recovery. The team is conducting a carefully controlled experiment involving up to 120 individuals who are currently taking buprenorphine. The goal is to see if adding a series of weekly brain stimulation sessions can reduce the urge to use opioids more effectively than a fake treatment that looks and sounds the same but delivers no magnetic energy. The researchers are focusing on a specific area of the brain called the left dorsolateral prefrontal cortex, a region involved in self-control and decision-making. They are using a pattern of stimulation called intermittent theta burst stimulation, which delivers short, rapid bursts of magnetic energy designed to strengthen the connections between brain cells.
To find out if this approach works, the study divides participants into two groups. One group receives the active magnetic treatment, while the other receives the sham treatment, where the machine is turned on but the coil is flipped so no pulses reach the brain. Neither the participants nor the staff assessing their progress know who is receiving which treatment, ensuring that the results are based on the therapy itself rather than expectations. Over the course of eight weeks, participants visit the clinic once a week. During each visit, they receive two sessions of stimulation, separated by a short break, for a total of sixteen sessions. Before the first session and after the final one, and at several points in between, the researchers measure how much the participants crave opioids and how often they have used them. They also track whether the participants remain in their treatment programs.
A unique feature of this study is that it is not just testing the treatment in a university hospital, but also in a private outpatient clinic. This design allows the researchers to see if the treatment works in the real-world settings where most people receive their care, rather than only in highly specialized academic centers. Additionally, a smaller group of volunteers will undergo brain scans before and after the treatment. These scans allow the scientists to look inside the brain and see if the magnetic pulses actually change the way different regions communicate with each other. Specifically, they are looking for changes in the connection between the decision-making area of the brain and the regions that drive craving and habit.
The study is still in progress, with recruitment beginning in the summer of 2026 and data collection expected to continue through late 2028. Because the trial is ongoing, the researchers have not yet announced whether the treatment was successful. However, the protocol itself represents a significant step forward in how scientists approach the problem of relapse. By testing a schedule that fits into a typical weekly clinic visit, rather than demanding daily hospital trips, the team is asking a practical question: can a treatment that is effective also be simple enough for people to stick with? If the magnetic pulses do succeed in lowering cravings and keeping people in treatment, it would suggest a new, safe way to support the millions of people fighting to overcome opioid use disorder, offering a tool that works alongside medication to heal the brain's desire for drugs.
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