Robertas Badaras
Vilnius University, Lithuania
Title: Opioid detoxification without stress – Mission NOT impossible
Biography
Biography: Robertas Badaras
Abstract
Antagonist induction in opioid antagonist assisted abstinence remains problematic due to its pronounced withdrawal effects. This study aimed to compare stress response by using two naltrexone induction protocols. A double-blind, randomized clinical trial was registered in ClinicalTrials.gov (Identifier: NCT02362256). For antagonist induction, the Control Group (CG) received a single 12.5 mg oral dose of naltrexone while the Intervention Group (IG) received an escalating regimen, starting with 50 µg, followed by gradually increasing doses to a cumulative dose of 12.5 mg. All patients received 25 mg of naltrexone on the following day and 50 mg on the day after. Both groups received a fixed protocol of clonidine and lorazepam, with additional doses given when marginal thresholds were exceeded on the Subjective (SOWS) and Objective (OOWS) Opioid Withdrawal scales. Adrenocorticotropic hormone (ACTH), cortisol levels, and SOWS and OOWS were markers of stress response and severity of withdrawal.
A single 12.5 mg naltrexone dose nearly doubled the ACTH concentration compared to baseline and caused statistically significant increase in cortisol concentration, OOWS and SOWS in CG. These values were below baseline at 1 and 5 h time-points in the intervention group. Differences between the CG and IG were statistically significant. There were no differences between the two groups after 24 h. In contrast to a single 12.5 mg dose, the escalating naltrexone dosing regimen did not produce a measurable withdrawal or stress response during antagonist induction.