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Acta Neurologica Belgica

06.12.2024 | Research

Hypoxic brain damage in Methadone misuse: insights from MRI imaging and comparative study

verfasst von: Ali Shamooshaki, Fariborz Faeghi, Hossein Jomleh, Amin Azizian, Dayan Amanian, Reza Kouhi

Erschienen in: Acta Neurologica Belgica

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Abstract

Background

This study aimed to investigate the potential presence of brain disorders, particularly hypoxia, via magnetic resonance imaging (MRI) in patients misusing methadone, with a comparison to regular opium users and a control group.

Methods

Conducted as a cross-sectional comparative study at Kamali Hospital in Karaj, Iran, the research included male participants comprising methadone users, opium users, and controls. Inclusion criteria were stringent, focusing on substance use duration and absence of brain structural disorders. MRI scans were performed using a 1.5T MRI scanner. Qualitative MRI assessments and chi-square tests analyzed associations between substance use and hypoxia, while logistic regression examined potential confounding variables.

Results

Significant hypoxia was observed in the methadone group (16.7%, 5/24; p = 0.00057), with no cases in the opium or control groups. Logistic regression analysis showed no significant predictors of hypoxia regarding dose and duration of use. MRI findings in methadone users with hypoxia included varied ADC intensities, high signal intensities on T2-weighted and diffusion-weighted imaging (DWI) sequences, and angiogenesis patterns on TOF sequences. The co-use of methadone and alcohol was noted in three of the five hypoxia cases.

Conclusion

Methadone misuse, particularly with alcohol, poses a significant risk of hypoxia, detectable via MRI. This study underscores the need for routine MRI monitoring, stricter regulation of non-prescribed methadone, and enhanced public health education to mitigate misuse risks. Future research should expand sample sizes and incorporate advanced imaging techniques to further elucidate methadone’s neurological impact.
Literatur
1.
Dinis-Oliveira RJ (2016) Metabolomics of methadone: clinical and forensic toxicological implications and variability of dose response. Drug Metab Rev 48(4):568–576PubMedCrossRef
2.
Dole VP, Nyswander M (1965) A medical treatment for diacetylmorphine (heroin) addiction. A clinical trial with methadone hydrochloride. JAMA 193:646–650PubMedCrossRef
3.
Kristensen K, Christensen CB, Christrup LL (1995) The mu1, mu2, delta, kappa opioid receptor binding profiles of methadone stereoisomers and morphine. Life Sci 56(2):Pl45–50PubMedCrossRef
4.
Peng PW, Tumber PS, Gourlay D (2005) Review article: perioperative pain management of patients on methadone therapy. Can J Anaesth 52(5):513–523PubMedCrossRef
5.
Hagen NA, Fisher K, Stiles C (2007) Sublingual methadone for the management of cancer-related breakthrough pain: a pilot study. J Palliat Med 10(2):331–337PubMedCrossRef
6.
Lugo R, Satterfield K, Kern S (2005) Pharmacokinetics of Methadone. J Pain Palliat Care Pharm 19:13–24
7.
Inturrisi CE (2005) Pharmacology of methadone and its isomers. Minerva Anestesiol 71(7–8):435–437PubMed
8.
Brown R, Kraus C, Fleming M, Reddy S (2004) Methadone: applied pharmacology and use as adjunctive treatment in chronic pain. Postgrad Med J 80(949):654–659PubMedPubMedCentralCrossRef
9.
Gudin J, Fudin J, Nalamachu S (2016) Levorphanol use: past, present and future. Postgrad Med 128(1):46–53PubMedCrossRef
10.
Ripamonti C, Zecca E, Bruera E (1997) An update on the clinical use of methadone for cancer pain. Pain 70(2):109–115PubMedCrossRef
11.
Kreek MJ (1994) Biological correlates of methadone maintenance pharmacotherapy. Ann Med Interne (Paris) 145(Suppl 3):9–14PubMed
12.
Gourlay GK, Willis RJ, Lamberty J (1986) A double-blind comparison of the efficacy of methadone and morphine in postoperative pain control. Anesthesiology 64(3):322–327PubMedCrossRef
13.
14.
Mizoguchi H, Watanabe C, Yonezawa A, Sakurada S (2009) New therapy for neuropathic pain. Int Rev Neurobiol 85:249–260PubMedCrossRef
15.
Schwartz RP, Brooner RK, Montoya ID, Currens M, Hayes M (1999) A 12-year follow-up of a methadone medical maintenance program. Am J Addict 8(4):293–299PubMedCrossRef
16.
BESWICK T, BEST D, REES S, COOMBER R, GOSSOP M (2001) Multiple drug use: patterns and practices of heroin and crack use in a population of opiate addicts in treatment. Drug Alcohol Rev 20(2):201–204CrossRef
17.
Gourevitch MN, Friedland GH (2000) Interactions between methadone and medications used to treat HIV infection: a review. Mt Sinai J Med 67(5–6):429–436PubMed
18.
Taburet AM, Singlas E (1996) Drug interactions with antiviral drugs. Clin Pharmacokinet 30(5):385–401PubMedCrossRef
19.
Bruce RD, Altice FL, Gourevitch MN, Friedland GH (2006) Pharmacokinetic drug interactions between opioid agonist therapy and antiretroviral medications: implications and management for clinical practice. J Acquir Immune Defic Syndr 41(5):563–572PubMedCrossRef
20.
Schlatter J, Madras JL, Saulnier JL, Poujade F (1999) [Drug interactions with methadone]. Presse Med 28(25):1381–1384PubMed
21.
Hsu A, Granneman GR, Bertz RJ, Ritonavir (1998) Clinical pharmacokinetics and interactions with other anti-HIV agents. Clin Pharmacokinet 35(4):275–291PubMedCrossRef
22.
Gagajewski A, Apple FS (2003) Methadone-related deaths in Hennepin County, Minnesota: 1992–2002. J Forensic Sci 48(3):668–671PubMedCrossRef
23.
Ballesteros MF, Budnitz DS, Sanford CP, Gilchrist J, Agyekum GA, Butts J (2003) Increase in deaths due to methadone in North Carolina. JAMA 290(1):40PubMedCrossRef
24.
Leonard J, Paulozzi M, Karin A, Mack, PhD CM, Jones (2012) PharmD. Risk for Overdose from Methadone Used for Pain Relief. Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC.: Morbidity and Mortality Weekly Report (MMWR); July 3
25.
Webster LR (2013) Methadone side effects: Constipation, respiratory depression, sedation, sleep-disordered breathing, and the endocrine system. pp. 39–49
26.
Salgado RA, Jorens PG, Baar I, Cras P, Hans G, Parizel PM (2010) Methadone-induced toxic leukoencephalopathy: MR imaging and MR Proton spectroscopy findings. AJNR Am J Neuroradiol 31(3):565–566PubMedPubMedCentralCrossRef
27.
Carroll I, Heritier Barras AC, Dirren E, Burkhard PR, Horvath J (2012) Delayed leukoencephalopathy after alprazolam and methadone overdose: a case report and review of the literature. Clin Neurol Neurosurg 114(6):816–819PubMedCrossRef
28.
Bileviciute-Ljungar I, Häglund V, Carlsson J, von Heijne A (2014) Clinical and radiological findings in methadone-induced delayed leukoencephalopathy. J Rehabil Med 46(8):828–830PubMedCrossRef
29.
30.
Vella S, Kreis R, Lovblad KO, Steinlin M (2003) Acute leukoencephalopathy after inhalation of a single dose of heroin. Neuropediatrics 34(2):100–104PubMedCrossRef
31.
Mittal M, Wang Y, Reeves A, Newell K (2010) Methadone-induced delayed posthypoxic encephalopathy: clinical, radiological, and pathological findings. Case Rep Med 2010:716494PubMedPubMedCentralCrossRef
32.
Hunt G, Bruera E (1995) Respiratory depression in a patient receiving oral methadone for cancer pain. J Pain Symptom Manage 10(5):401–404PubMedCrossRef
33.
Sweeney MM, Antoine DG, Nanda L, Géniaux H, Lofwall MR, Bigelow GE et al (2019) Increases in body mass index and cardiovascular risk factors during methadone maintenance treatment. J Opioid Manag 15(5):367–374PubMedCrossRef
34.
Fenn JM, Laurent JS, Sigmon SC (2015) Increases in body mass index following initiation of methadone treatment. J Subst Abuse Treat 51:59–63PubMedCrossRef
35.
Krantz MJ, Lewkowiez L, Hays H, Woodroffe MA, Robertson AD, Mehler PS (2002) Torsade De Pointes associated with very-high-dose methadone. Ann Intern Med 137(6):501–504PubMedCrossRef
36.
Martell BA, Arnsten JH, Krantz MJ, Gourevitch MN (2005) Impact of methadone treatment on cardiac repolarization and conduction in opioid users. Am J Cardiol 95(7):915–918PubMedCrossRef
37.
Garrido MJ, Trocóniz IF (1999) Methadone: a review of its pharmacokinetic/pharmacodynamic properties. J Pharmacol Toxicol Methods 42(2):61–66PubMedCrossRef
38.
Gorman AL, Elliott KJ, Inturrisi CE (1997) The d- and l-isomers of methadone bind to the non-competitive site on the N-methyl-D-aspartate (NMDA) receptor in rat forebrain and spinal cord. Neurosci Lett 223(1):5–8PubMedCrossRef
39.
40.
Codd EE, Shank RP, Schupsky JJ, Raffa RB (1995) Serotonin and norepinephrine uptake inhibiting activity of centrally acting analgesics: structural determinants and role in antinociception. J Pharmacol Exp Ther 274(3):1263–1270PubMed
41.
Ebert B, Andersen S, Krogsgaard-Larsen P (1995) Ketobemidone, methadone and pethidine are non-competitive N-methyl-D-aspartate (NMDA) antagonists in the rat cortex and spinal cord. Neurosci Lett 187(3):165–168PubMedCrossRef
42.
Davis AM, Inturrisi CE (1999) d-Methadone blocks morphine tolerance and N-methyl-D-aspartate-induced hyperalgesia. J Pharmacol Exp Ther 289(2):1048–1053PubMed
43.
Bravo L, Llorca-Torralba M, Berrocoso E, Micó JA (2019) Monoamines as drug targets in Chronic Pain: focusing on Neuropathic Pain. Front Neurosci 13:1268PubMedPubMedCentralCrossRef
44.
45.
Murphy GS, Wu CL, Mascha EJ (2019) Methadone: new indications for an Old Drug? Anesth Analg 129(6):1456–1458PubMedCrossRef
46.
Fudin HRBJ, Hong JT, KuJ, May AL, Wisner A et al (2018) Side effects of drugs Annual, 1 edn. Elsevier, p 694
47.
George F (2014) Koob MAAaMLM. Drugs, addiction, and the brain. Drugs, addiction, and the brain, 1 edn. Elsevier, Academic Press, p 350
48.
Madjova C, Chokanov S, Milkov M, CORRELATION BETWEEN SLEEP APNEA (2021) AND METHADONE THERAPY. Journal of IMAB - Annual Proceeding (Scientific Papers)
49.
Webster LR (ed) Methadone Side Effects: Constipation, Respiratory Depression, Sedation, Sleep-Disordered Breathing, and the Endocrine System2013
50.
Correa D, Farney RJ, Chung F, Prasad A, Lam D, Wong J (2015) Chronic opioid use and central sleep apnea: a review of the prevalence, mechanisms, and perioperative considerations. Anesth Analg 120(6):1273–1285PubMedCrossRef
51.
Charpentier A, Bisac S, Poirot I, Vignau J, Cottencin O (2010) Sleep quality and apnea in stable methadone maintenance treatment. Subst Use Misuse 45(9):1431–1434PubMedCrossRef
52.
Schlaug G, Siewert B, Benfield A, Edelman RR, Warach S (1997) Time course of the apparent diffusion coefficient (ADC) abnormality in human stroke. Neurology 49(1):113–119PubMedCrossRef
53.
Xu XQ, Cheng QG, Zu QQ, Lu SS, Yu J, Sheng Y et al (2014) Comparative study of the relative signal intensity on DWI, FLAIR, and T2 images in identifying the onset time of stroke in an embolic canine model. Neurol Sci 35(7):1059–1065PubMedCrossRef
54.
Gerbasi A, Konduri P, Tolhuisen M, Cavalcante F, Rinkel L, Kappelhof M et al (2022) Prognostic value of combined Radiomic features from Follow-Up DWI and T2-FLAIR in Acute ischemic stroke. J Cardiovasc Dev Dis 9(12):468PubMedPubMedCentral
55.
Muttikkal TJ, Wintermark M (2013) MRI patterns of global hypoxic-ischemic injury in adults. J Neuroradiol 40(3):164–171PubMedCrossRef
56.
Harris AD, Murphy K, Diaz CM, Saxena N, Hall JE, Liu TT et al (2013) Cerebral blood flow response to acute hypoxic hypoxia. NMR Biomed 26(12):1844–1852PubMedPubMedCentralCrossRef
57.
De Lima L, Pastrana T, Radbruch L, Wenk R (2014) Cross-sectional pilot study to monitor the availability, dispensed prices, and affordability of opioids around the globe. J Pain Symptom Manage 48(4):649–59e1PubMedCrossRef
Metadaten
Titel
Hypoxic brain damage in Methadone misuse: insights from MRI imaging and comparative study
verfasst von
Ali Shamooshaki
Fariborz Faeghi
Hossein Jomleh
Amin Azizian
Dayan Amanian
Reza Kouhi
Publikationsdatum
06.12.2024
Verlag
Springer International Publishing
Erschienen in
Acta Neurologica Belgica
Print ISSN: 0300-9009
Elektronische ISSN: 2240-2993
DOI
https://doi.org/10.1007/s13760-024-02678-8

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