Vilnius University, Lithuania
Robertas Badaras MD, PhD, Head of Toxicology Centre in Vilnius University Faculty of Medicine, and also Head of Toxicology Centre in Vilnius University Emergency hospital, also working as the consultant in Lithuanian Poison bureau. The fields of his interests: intensive care in toxicology, methods of extracorporeal detoxifications, detoxification from psychoactive substances, clinical nutrition in ICU. Last few years he started to provide opioid detoxifications for cancer and non-cancer pain patients, who became addicted to prescription opioids. He is the teacher for students, residents, provide courses for doctors, participating in national and international professional meetings with scientific presentations.
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.