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Evaluation of the opioid addiction test in an out-patient drug dependency unit

Published online by Cambridge University Press:  03 January 2018

A. H. Ghodse*
Affiliation:
Department of Addictive Behaviour and Psychological Medicine, St George's Hospital Medical School, London
J. L. Greaves
Affiliation:
Department of Addictive Behaviour and Psychological Medicine, St George's Hospital Medical School, London
D. Lynch
Affiliation:
Department of Addictive Behaviour and Psychological Medicine, St George's Hospital Medical School, London
*
Professor A. H. Ghodse, Department of Addictive Behaviour and Psychological Medicine. St George's Hospital Medical School, Cranmer Terrace, Tooting, London SW17 0RE

Abstract

Background

The opioid addiction test is based on the measurement of pupil dilatation in opioid-dependent people in response to conjunctivally applied naloxone hydrochloride. A positive response (pupil dilatation) indicates that the subject is dependent on opioids.

Aims

To evaluate the test in an out-patient setting and to identify factors affecting its outcome.

Method

Pupil size was measured using binocular pupillometry in 100 new patients attending an out-patient clinic for assessment and treatment of opioid use. Measurement was repeated 40 minutes after the unilateral instillation of naloxone drops into the conjunctival sac.

Results

We performed 127 tests, of which 103 (81.1%) were positive. Males, and those not on methadone at the time of the test, were more likely to have a negative test result.

Conclusions

The opioid addiction test proved to be a very useful tool for the rapid diagnosis of opioid dependence in the out-patient clinic. Specialist pupillometric equipment increases the number of patients correctly identified as opioid-dependent on the first visit, but is not essential.

Type
Papers
Copyright
Copyright © 1999 The Royal College of Psychiatrists 

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References

Bellini, C., Boccuni, M., D'Egldio, P., et al (1982) Naloxone anisocoria: a non-invasive, inexpensive test for opiate addiction. International Journal of Clinical Pharmocology Research, 2, 5560.Google Scholar
Berkowitz, B. A. (1976) The relationship of pharmacokinetics to pharmacological activity: morphine, methadone and naloxone. Clinical Pharmacokinetics, 1, 219230.CrossRefGoogle ScholarPubMed
Calrnie, A. B., Kosterlitz, H. W. & Taylor, D. W. (1961) Effects of morphine on some sympathetically innervated effectors. British Journal of Pharmacology, 17, 539551.Google Scholar
Crelghton, F. J. & Ghodse, A. H. (1989) Naloxone applied to conjunctiva as a test for physical opiate dependence. Lancet, 333, 748750.Google Scholar
Dean, G. (1994) Manual of Epi Info Version 6. Atlanta, GA: Centers for Disease Control and Prevention.Google Scholar
Drago, F., Gorgone, G., Spina, F., et al (1980) Opiate receptors in the rabbit iris. Naunyn–Schmieddeberg's Archives of Pharmacology, 315, 14.Google Scholar
Fanciullacci, M., Boccuni, M., Pietrini, U., et at (1980) The naloxone conjunctival test in morphine addiction. European Journal of Pharmacology, 61, 319320.Google Scholar
Fanciullacci, M., Boccuni, M., Pietrini, U., et al (1981) Search for opiate receptors in the human pupil. International Journal of Clinical Pharmacology Research 1, 139143.Google Scholar
Fraunfelder, F. T. (1989) Drug Induced Ocular Side Effects and Drug Interactions (3rd edn) (ed. Meyer, S. M.), pp. 82155. Philadelphia, RA: Lea & Febiger Google Scholar
Ghodse, A. H. (1989) Opiate Withdrawal Symptom Questionnaire. In Drugs and Addictive Behaviour–A Guide to Treatment, p. 319 Oxford: Blackwell.Google Scholar
Ghodse, A. H., Bewley, T. H., Kearney, M. K., et al (1986) Mydriatic response to topical naloxone in opiate abusers. British Journal of Psychiatry, 148, 4446.Google Scholar
Ghodse, A. H., Taylor, D. R. S., Britten, A. J., et al (1995) The opiate addiction test: a clinical evaluation of a quick test for physical dependence on opiate drugs. British Journal of Clinical Pharmacology, 39, 257259.Google Scholar
Lee, H. K. & Wang, S. C. (1975) Mechanism of morphine induced miosis in the dog. Journal of Pharmacology and Experimental Therapeutics, 192, 415431.Google Scholar
Murray, R. B., Adler, M. W. & Korczyn, A. (1983) The pupillary effects of opioids. Life Sciences, 33, 495509.Google Scholar
Nomof, N., Eliiott, H. W. & Parker, K. D. (1968) The local effect of morphine, nalorphine and codeine on the diameter of the pupil of the eye. Clinical Pharmacology and Therapeutics, 9, 358364.Google Scholar
Sanchez-Ramos, J. R. & Senay, E. C. (1987) Ophthalmic naloxone elicits abstinence in opioid dependent subjects. British Journal of Addiction, 82, 313315.Google Scholar
SAS Institute Inc. (1985) SAS User's Guide: Statistics (version 5). Cary, NC: SAS Institute.Google Scholar
Sharpe, L. G. & Pickworth, W. B. (1981) Pharmacologic evidence for a tonic muscarinic inhibitory input to the Edinger–Westphal Nucleus in the dog. Experimental Neurology, 71, 176190.Google Scholar
Thompson, S. H. (1992) The pupil. In Adlers Physiology of the Eye–Clinical Application (9th edn) (ed. Hart, W. M. Jr), pp. 418423. St Louis, MO: Mosby Year Book.Google Scholar
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