May 31, 2019 Conference
Ms. Natalie Sadlak, Boston Medical Center (Presenter)
Shaleen Sathe, Boston Medical Center
Michael Paasche-Orlow, Boston Medical Center
Zoe Weinstein, Boston Medical Center
Nina Tamashunas, Boston Medical Center
Ms. Wanjiku (Shiko) Githere, Boston Medical Center
Marissa Fiorello, Boston Medical Center
Howard Cabral, Boston Medical Center
Dr. Crandall Peeler, Boston Medical Center
Introduction: The goal of opioid agonist therapy in addiction treatment is to control a patient’s withdrawal symptoms without causing excess sedation. Tolerance to opioid medication is variable and dosage decisions are based on a combination of a patient’s reported symptoms and clinically observed signs of withdrawal, including a rough estimate of pupil size that is prone to interobserver variability. The goal of this study was to determine whether more precise measurements of pupil size and reactivity, obtained using automated infrared pupillometry, might aid in the dosing of opioid agonist therapy.
Method: A prospective study of inpatients at an urban academic hospital between the age of 18 and 50 seeking treatment for opioid addition. Patients on opiate agonist therapy (methadone or buprenorphine/naloxone) consented to have pupil size and several reactivity variables measured - once before and at several time points after medication dosage - using a NeuroOptics NPi-200 pupillometer. Withdrawal symptoms and signs were also assessed using the Clinical Opioid Withdrawal Scale (COWS), the current standard for dosing opioid agonist therapy. Additionally, a survey measuring patient satisfaction with withdrawal symptom control was administered following dosing.
Results: We enrolled 20 patients (70% male, average age 33.2 years) in the study. There was a statistically significant decrease in pupil size (both light and dark) and dilation velocity when comparing pre-dosing measurements to those obtained at 30 and 60 minutes post-dosing. There was no significant change in constriction velocity, percent constriction, or latency time.
Conclusions: We report a significant change in pupil size and dilation velocity following administration of opioid agonist therapy. With a larger patient cohort, we hope to identify an average change in these parameters corresponding to optimal control of opioid withdrawal symptoms. We hope that this will provide a more objective tool in the initial dosing of opioid replacement therapy and help to prevent relapse.