Non-invasive Vagal Nerve Stimulation in Opioid Use Disorders UH3

Inclusion Criteria:

* Meet criteria for OUDs based on the DSM5 criteria
* Willing to undergo supervised withdrawal
* Willing to be transitioned to a MOUD or behavioral management during treatment aftercare

Exclusion Criteria:

* Positive pregnancy test or breastfeeding for women
* History of meningitis
* Traumatic brain injury
* Current treatment with methadone, naltrexone, or Suboxone or medications that would be contraindicated with hydromorphone or clonidine administration
* History of head trauma resulting in loss of consciousness (LOC) of greater than one minute where the LOC is not judged to be primarily related to overdose in the judgment of the study physician
* Past year moderate to severe non-opioid use disorders that would require separate withdrawal management
* Current or lifetime history of schizophrenia, schizoaffective disorder, or bulimia
* History of serious medical or neurological illness or organic mental disorder, including liver disease, but also including cardiovascular, gastrointestinal, hepatic, renal, neurologic, or other systemic illness, including liver enzymes aspartate transaminase (AST) and alanine transaminase (ALT) more than three times upper limit of normal, that would preclude involvement based on the clinical judgment of the study psychiatrist
* Lack of venous access that would preclude PET imaging
* Active implantable device (i.e. pacemaker) or other VNS device exclusion
* History of shrapnel or other foreign bodies that would preclude MRI scanning
* Positive test for COVID-19