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[Rapid opiate detoxification under anesthesia (RODA)].

Revue medicale de Liege (2013-07-31)
N Dubols, C Hallet, D Luppens, M Ansseau, C Charlier
PMID23888580
ABSTRACT

Rapid Opiate Detoxification under Anesthesia (RODA) involves the use of opiate antagonists combined with anesthesia and pharmacotherapy to reduce withdrawal symptoms. The aim of our study was to measure the plasma concentrations of heroin metabolites and methadone during anesthesia and patient stay at the hospital in order to assess the amount of active substances at each protocol step. Plasma concentrations of antagonists were also quantified and compared to the recommended target values. Blood samples were drawn in 10 patients undergoing RODA at different times of the procedure (during anesthesia, in post-anesthesia care unit and in psychiatry unit). The plasma concentrations of heroin metabolites, methadone and antagonists were measured using a previously described method. Heroin active metabolites were no longer detected in the patient blood when helshe left the hospital; by contrast, methadone was still present at significant concentrations 3 days after the beginning of the detoxification procedure. Naltrexone analysis allowed us to adjust doses to insure opiate receptor blockade during acute withdrawal, which is a critical period.

MATERIALS
Product Number
Brand
Product Description
M-007
Supelco
(±)-Methadone solution, 1 mg/mL in methanol, ampule of 1 mL, certified reference material, Cerilliant®
M-005
Supelco
Morphine solution, 1.0 mg/mL in methanol, ampule of 1 mL, certified reference material, Cerilliant®
M-030
Supelco
Morphine solution, 100 μg/mL in methanol, ampule of 1 mL, certified reference material, Cerilliant®
N7758
Sigma-Aldrich
Naloxone hydrochloride dihydrate, ≥98% (TLC and titration), powder
M0267
Sigma-Aldrich
(±)-Methadone hydrochloride, powder, ≥98%
M9524
Supelco
Morphine sulfate salt solution, 1.0 mg/mL in methanol, drug standard
M8777
Sigma-Aldrich
Morphine sulfate salt pentahydrate
M-018
Supelco
Morphine-3-β-D-glucuronide solution, 100 μg/mL in methanol: water ( 50:50(v/v)), ampule of 1 mL, certified reference material, Cerilliant®
M-031
Supelco
Morphine-3-β-D-glucuronide solution, 1 mg/mL in methanol with 0.05% NaOH, ampule of 1 mL, certified reference material, Cerilliant®
M-046
Supelco
Morphine-6-β-D-glucuronide solution, 1.0 mg/mL in methanol: water (2:8), ampule of 1 mL, certified reference material, Cerilliant®
N-004
Supelco
Naloxone solution, 1.0 mg/mL in methanol, ampule of 1 mL, certified reference material, Cerilliant®
M-096
Supelco
Morphine-6-β-D-glucuronide solution, 100 μg/mL in methanol: water (1:1), ampule of 1 mL, certified reference material, Cerilliant®
N-007
Supelco
Naltrexone solution, 1.0 mg/mL in methanol, ampule of 1 mL, certified reference material, Cerilliant®