{
  "abstract": "Background: Individuals receiving buprenorphine treatment for opioid use disorder (OUD) remain at high risk for treatment discontinuation and return to opioid use. Transcranial magnetic stimulation (TMS) has shown efficacy in reducing craving and substance use in other substance use disorders, but its application in OUD remains limited and the neural mechanism underlying its therapeutic effects is poorly understood. Determining the feasibility and generalizability of TMS in patients receiving buprenorphine – the most commonly prescribed medication for OUD – is therefore critical. This protocol aims to address these issues in a clinical trial of weekly TMS sessions for OUD. Methods: We will enroll up to 120 individuals with OUD taking buprenorphine in a randomized, single-blind, sham-controlled trial of left dorsolateral prefrontal cortex (DLPFC)-targeted intermittent theta burst stimulation (iTBS). Participants will receive active or sham iTBS weekly (2 sessions of 1800 pulses each applied once per week x 8 weeks, 16 sessions total) with pre- and post-iTBS assessments (10, 12, 20 weeks) of craving, opioid use, and treatment retention. A subset of individuals will undergo optional pre- and post-iTBS neuroimaging. The study will be conducted at an academic medical center and a private outpatient TMS clinic. Aims: Our primary aim is to determine whether 16 sessions of active iTBS applied to the left DLPFC results in reduced craving and opioid use, and higher treatment retention, relative to sham. In a secondary aim, we will also examine whether iTBS-related changes in craving are associated with changes in functional connectivity between the left DLPFC and both the dorsal striatum and anterior cingulate cortex. Discussion: By evaluating the feasibility and efficacy of a weekly TMS protocol that aligns with routine care and focuses on patients maintained on buprenorphine, this study addresses key limitations of prior TMS research in OUD. Furthermore, the inclusion of neuroimaging will help characterize the neural mechanisms underlying TMS-related changes in craving. Trial registration: This clinical trial is registered at ClinicalTrials.Gov; ID NCT07457489; date of registration: 03/02/2026.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America",
    "Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America",
    "Synaptic PSYCH, Brentwood, Tennessee, United States of America"
  ],
  "article_type": "Study Protocol",
  "arxiv": null,
  "author_total": 21,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Kathryn Biernacki"
    },
    {
      "affs": [
        1
      ],
      "name": "Jillian Connolly"
    },
    {
      "affs": [
        2
      ],
      "name": "Libby Tunison"
    },
    {
      "name": "Kristopher A. Kast"
    },
    {
      "name": "Simon Vandekar"
    },
    {
      "name": "Benson King"
    },
    {
      "name": "Tashley Aouina"
    },
    {
      "name": "Beth Black"
    },
    {
      "name": "Rachel Craig"
    },
    {
      "name": "Jason Ferrell"
    },
    {
      "name": "Christopher A. Grimes"
    },
    {
      "name": "Lauren Horowitz"
    },
    {
      "name": "Michael Levin"
    },
    {
      "name": "Mariah Smith"
    },
    {
      "name": "Linda Sok"
    },
    {
      "name": "Amanda von Horn"
    },
    {
      "name": "Kyle York"
    },
    {
      "name": "Steven Somers"
    },
    {
      "name": "Jonathan Becker"
    },
    {
      "name": "Michelle Cochran"
    },
    {
      "name": "Heather Burrell Ward"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/c84fq1yg22fb3.bib",
  "cited_by": 0,
  "doi": "10.1371/journal.pone.0357402",
  "fulltext_url": null,
  "id": "c84fq1yg22fb3",
  "issns": [
    "1932-6203"
  ],
  "landing_url": "https://doi.org/10.1371/journal.pone.0357402",
  "language": null,
  "licence": "CC-BY-4.0",
  "licence_label": "CC BY 4.0",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "openalex",
      "2808|Transcranial Magnetic Stimulation Studies"
    ],
    [
      "plos",
      "/Biology and life sciences/Anatomy/Brain/Neostriatum"
    ],
    [
      "plos",
      "/Biology and life sciences/Neuroscience/Brain mapping/Transcranial stimulation/Transcranial magnetic stimulation"
    ],
    [
      "plos",
      "/Biology and life sciences/Neuroscience/Neuroimaging"
    ],
    [
      "plos",
      "/Biology and life sciences/Neuroscience/Neurophysiology/Brain electrophysiology/Transcranial stimulation/Transcranial magnetic stimulation"
    ],
    [
      "plos",
      "/Biology and life sciences/Physiology/Electrophysiology/Neurophysiology/Brain electrophysiology/Transcranial stimulation/Transcranial magnetic stimulation"
    ],
    [
      "plos",
      "/Medicine and health sciences/Anatomy/Brain/Neostriatum"
    ],
    [
      "plos",
      "/Medicine and health sciences/Diagnostic medicine/Diagnostic radiology/Magnetic resonance imaging"
    ],
    [
      "plos",
      "/Medicine and health sciences/Mental health and psychiatry/Mental health therapies"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pain management/Analgesics/Opioids"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pharmaceutics/Drug therapy"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pharmaceutics/Drug therapy/Neurological drug therapy/Anti-addiction drug therapy/Nicotine replacement therapy"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pharmacology/Drugs/Analgesics/Opioids"
    ],
    [
      "plos",
      "/Medicine and health sciences/Pharmacology/Drugs/Opioids"
    ],
    [
      "plos",
      "/Medicine and health sciences/Radiology and imaging/Diagnostic radiology/Magnetic resonance imaging"
    ],
    [
      "plos",
      "/Research and analysis methods/Bioassays and physiological analysis/Electrophysiological techniques/Brain electrophysiology/Transcranial stimulation/Transcranial magnetic stimulation"
    ],
    [
      "plos",
      "/Research and analysis methods/Imaging techniques/Diagnostic radiology/Magnetic resonance imaging"
    ],
    [
      "plos",
      "/Research and analysis methods/Imaging techniques/Neuroimaging"
    ]
  ],
  "openalex": "W7212126078",
  "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0357402&type=printable",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-10",
  "publisher": "Public Library of Science",
  "ris": "https://research.draconitic.com/paper/c84fq1yg22fb3.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:56Z",
      "native_id": "10.1371/journal.pone.0357402",
      "source": "plos",
      "url": "https://doi.org/10.1371/journal.pone.0357402"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "plos:neuroscience",
      "subfield": "neuroscience"
    },
    {
      "field": "medicine",
      "origin": "plos:diagnostic radiology",
      "subfield": "imaging"
    },
    {
      "field": "medicine",
      "origin": "plos:anatomy",
      "subfield": "physiology"
    }
  ],
  "title": "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",
  "title_text": "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",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:56Z",
  "url": "https://research.draconitic.com/paper/c84fq1yg22fb3",
  "venue": "PLOS One",
  "versions": []
}