Evaluation of Serum Cortisol Levels and Response to Cosyntropin Test inMethadone-Treated Opium Addicts

Backgroun: Opium has been used for thousands of years for medical and analgesic purposes and also itsmisuse has increased in recent years. Methadone, a synthetic opioid has been used as an analgesic and tohelp patients quit opium addiction. However, some evidence suggest long-term use of opioids can affecthypothalamic-pituitary-adrenal axis. To assess this hypothesis, we aimed to evaluate the serum cortisol leveland response to cosyntropin stimulation test in opium addicts under methadone treatment.Methods: The study was conducted in November of ۲۰۱۹ in Imam Reza Hospital Rehab Center, Birjand, Iran.۳۸ methadone-treated opium addicts participated in the study. Initially, ۵ cc of blood was taken, then, ۲۵۰ μgintramuscular cosyntropin was injected. After ۳۰ and ۶۰ minutes two other blood samples were obtained.These procedures were performed between ۸ to ۹ AM. The data were analyzed using SPSS.Results: The mean serum cortisol level in methadone users was ۹.۴۶ ± ۵.۴۲ μg/dl. The mean response tocosyntropin stimulation test in methadone users was ۹.۳۴± ۸.۱۱ μg / dl. ۵۵% of our participants had adrenalinsufficiency.there was a significant difference between serum cortisol levels in methadone users (۹.۴۶ ± ۵.۴۲ μg / dl) andits normal values (=۱۴ μg / dl) (p <۰.۰۰۱).Conclusions: Serum cortisol level was significantly different in methadone-treated patients compared tonormal values. Therefore, we recommend measuring serum cortisol level in long-term opioid users beforemajor medical procedures to use stress doses of corticosteroids if needed.

Keywords:

Adrenal insufficiency , Cortisol , Cosyntropin test , Methadone