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Straipsnis Naltreksono indukcijos metodikų poveikis opioidinės abstinencijos skalių pokyčiams greitosios opioidinės detoksikacijos metu

The Influence of Naltrexone Induction Method on Changes of Opioid Addiction Scores during Rapid Opioid Detoxification

  • Bibliographic Description: Robertas Badaras1), Indrė Vaitekonytė1), Alma Molytė1), Linas Zdanavičius2), Gabija Dragelytė2), Gabija Mikulevičienė1), Jurgis Garšva2), Mark Barkovski1), Janina Didžiapetrienė1), Juozas Ivaškevičius2), „Naltreksono indukcijos metodikų poveikis opioidinės abstinencijos skalių pokyčiams greitosios opioidinės detoksikacijos metu“, @eitis (lt), 2016, t. 749, ISSN 2424-421X.
  • Previous Edition: Robertas Badaras, Indrė Vaitekonytė, Alma Molytė, Linas Zdanavičius, Gabija Dragelytė, Gabija Mikulevičienė, Jurgis Garšva, Mark Barkovski, Janina Didžiapetrienė, Juozas Ivaškevičius, „Naltreksono indukcijos metodikų poveikis opioidinės abstinencijos skalių pokyčiams greitosios opioidinės detoksikacijos metu“, Acta medica Lituanica, 2015, t. 22. nr. 4, p. 223–233, ISSN 1392-0138.
  • Institutional Affiliation: 1) Vilniaus universiteto Medicinos fakultetas, 2) Respublikinė Vilniaus universitetinė ligoninė.

Summary. Opioid withdrawal is a subjectively severe, but frequently underestimated state if only its objective data is monitored. The Subjective and Objective Opioid Withdrawal Scales enable an accurate evaluation of both – subjective and objective symptoms and signs that occur during an opioid withdrawal. In order to make a quantitative analysis of opioid withdrawal, which occurs during an opioid detoxification procedure, a prospective, double-blind, randomised study was held. The aim of the research was to identify which of the two naltrexone induction techniques – starting from an initially small 50 μg dose and increasing it gradually to a total dose of 12.5 mg, or giving a single 12.5 mg dose – evokes a greater stress response and has higher influence on the acute antagonist evoked opioid withdrawal.

The research was held by implementing rapid opioid detoxification under a conscious sedation technique; at the end of the procedure an opioid antagonist naltrexone was administered orally. As the main quantitative indicators of the opioid withdrawal, the Subjective Opioid Withdrawal Scale (SOWS) and the Objective Opioid Withdrawal Scale (OOWS) were chosen. The study included 60 participants (41 men and 19 women), who were randomly divided into two groups of 30 persons each – a control group and a treatment group.

There was no significant difference among the groups in quantities of medications used during the rapid opioid detoxification procedure; that is why the results of SOWS and OOWS were not influenced by the variety of doses of medicine prescribed. The survey showed no statistically significant difference when comparing the results of the scales among the control and treatment groups either until the naltrexone induction started (morning of the 3rd day of the research). After the beginning of naltrexone induction, a significant improvement in opioid withdrawal treatment in the treatment group was registered: the values of SOWS and OOWS were significantly lower as compared to the ones before the induction. Meanwhile, the control group had opposite results: the subjective and objective values of the scales showed an exacerbation of opioid withdrawal after naltrexone induction. In the evening of the 3rd day, when the stress impact, evoked by the naltrexone induction, ended, both subjective and objective withdrawal expressions regressed into normal ranges and managed to match the values before the naltrexone induction in both groups. However, the treatment group showed less acutely expressed opioid withdrawal compared to the control group. On the 4th day of the research (1 day after naltrexone induction), the values in both subjective and objective opioid withdrawal scales in the treatment group were significantly lower compared to the values in the control group, giving the notion that the participants in the treatment group felt objectively and subjectively better than the participants in the control group.

Rapid opioid detoxification under a conscious sedation technique induces only mild or moderate changes in values of the subjective and objective opioid detoxification scales, giving a presumption of implementing this procedure in clinical practice without subjective and objective worsening of the patient’s condition. Naltrexone induction during rapid opioid detoxification under a conscious sedation procedure, starting from an initially small dose of 50 μg and increasing it gradually to a total dose of 12.5 mg, induces subjectively and objectively lower opioid withdrawal symptoms than they appear after a single 12.5 mg dose.

Keywords: naltrexone, objective opioid withdrawal scale, opioid detoxification, subjective opioid withdrawal scale.

 
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