Slow-Release Oral Morphine for the Treatment of Opioid Use Disorder

2019 ◽  
Author(s):  
Keyword(s):  
Slow Release ◽  
Oral Morphine ◽  
Opioid Use Disorder ◽  
Opioid Use

Transitioning a patient from injectable opioid agonist therapy to sublingual buprenorphine/naloxone for the treatment of opioid use disorder using a microdosing approach

2020 ◽  
Vol 13 (3) ◽  
pp. e233715 ◽  
Author(s):  
Mackenzie Duncan Gregory Caulfield ◽  
Rupinder Brar ◽  
Christy Sutherland ◽  
Seonaid Nolan
Keyword(s):  
Slow Release ◽  
Oral Morphine ◽  
Opioid Use Disorder ◽  
Evidence Based ◽  
Opioid Use ◽  
First Line ◽  
Agonist Therapy ◽  
Opioid Agonist ◽  
Evidence Based Treatment ◽  
Opioid Agonist Therapy

In the wake of North America’s opioid crisis, access to evidence-based treatment for opioid use disorder (OUD) is of critical importance. While buprenorphine/naloxone and methadone are currently indicated as first-line medications for the treatment of OUD, there are a proportion of individuals who do not benefit from these therapies. Recent Canadian guidelines suggest the use of alternate therapies, including slow-release oral morphine or injectable opioid agonist therapy (iOAT) for individuals unsuccessful with either methadone or buprenorphine/naloxone. While the guidelines highlight the need to intensify OUD treatment as disease severity increases, equally important is the consideration for deintensification of treatment (eg, from iOAT to an oral opioid agonist treatment (OAT) option) following successful stabilisation. Literature addressing how best to accomplish this, however, is currently lacking. Accordingly, the case presented here describes a patient that successfully transitions from iOAT to oral buprenorphine/naloxone using a novel induction approach termed microdosing.

scholarly journals Slow release oral morphine versus methadone for the treatment of opioid use disorder

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e025799 ◽  
Author(s):  
Jan Klimas ◽  
Lauren Gorfinkel ◽  
Salvatore M Giacomuzzi ◽  
Christian Ruckes ◽  
M Eugenia Socías ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Slow Release ◽  
Meta Analysis ◽  
Oral Morphine ◽  
Opioid Use Disorder ◽  
Treatment Retention ◽  
Controlled Trials ◽  
Randomised Trials ◽  
Opioid Use ◽  
Heroin Use

ObjectiveTo assess the efficacy of slow release oral morphine (SROM) as a treatment for opioid use disorder (OUD).DesignSystematic review and meta-analysis of randomised controlled trials (RCTs).Data sourcesThree electronic databases were searched through 1 May 2018: the Cochrane Central Register of Controlled Trials, MEDLINE and EMBASE. We also searched the following electronic registers for ongoing trials: ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Current Controlled Trials and the EU Clinical Trials Register.Eligibility criteria for selecting studiesWe included RCTs of all durations, assessing the effect of SROM on measures of treatment retention, heroin use and craving in adults who met the diagnostic criteria for OUD.Data extraction and synthesisTwo independent reviewers extracted data and assessed risk of bias. Data were pooled using the random-effects model and expressed as risk ratios (RRs) or mean differences with 95% CIs. Heterogeneity was assessed (χ2 statistic) and quantified (I2 statistic) and a sensitivity analysis was undertaken to assess the impact of particular high-risk trials.ResultsAmong 1315 records screened and four studies reviewed, four unique randomised trials met the inclusion criteria (n=471), and compared SROM with methadone. In the meta-analysis, we observed no significant differences between SROM and methadone in improving treatment retention (RR=0.98; 95%CI: 0.94 to 1.02, p=0.34) and heroin use (RR=0.96; 95% CI: 0.61 to 1.52, p=0.86). Craving data was not amenable to meta-analysis. Available data implied no differences in adverse events, heroin, cocaine or benzodiazepine use.ConclusionsMeta-analysis of existing randomised trials suggests SROM may be generally equal to methadone in retaining patients in treatment and reducing heroin use while potentially resulting in less craving. The methodological quality of the included RCTs was low-to-moderate.

scholarly journals Canadian Guidelines on Opioid Use Disorder Among Older Adults

2020 ◽  
Vol 23 (1) ◽  
pp. 123-134
Author(s):  
Launette M. Rieb ◽  
Zainab Samaan ◽  
Andrea D. Furlan ◽  
Kiran Rabheru ◽  
Sid Feldman ◽  
...  
Keyword(s):  
Older Adults ◽  
English Language ◽  
Oral Morphine ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Chronic Noncancer Pain ◽  
Assessment And Treatment ◽  
Noncancer Pain ◽  
Health Canada

BackgroundIn Canada, rates of hospital admission from opioid overdose are higher for older adults (≥ 65) than younger adults, and opioid use disorder (OUD) is a growing concern. In response, Health Canada commissioned the Canadian Coalition of Seniors’ Mental Health to create guidelines for the prevention, screening, assessment, and treatment of OUD in older adults.MethodsA systematic review of English language literature from 2008–2018 regarding OUD in adults was conducted. Previously published guidelines were evaluated using AGREE II, and key guidelines updated using ADAPTE method, by drawing on current literature. Recommendations were created and assessed using the GRADE method.ResultsThirty-two recommendations were created. Prevention recommendations: it is key to prioritize non-pharmacological and non-opioid strategies to treat acute and chronic noncancer pain. Assessment recommendations: a comprehensive assessment is important to help discern contributions of other medical conditions. Treatment recommendations: buprenorphine is first line for both withdrawal management and maintenance therapy, while methadone, slow-release oral morphine, or naltrexone can be used as alternatives under certain circumstances; non-pharmacological treatments should be offered as an integrated part of care.ConclusionThese guidelines provide practical and timely clinical recommendations on the prevention, assessment, and treatment of OUD in older adults within the Canadian context.

scholarly journals Cost-Effectiveness and Guidelines for Opioid Substitution Treatment

2021 ◽  
Vol 1 (12) ◽  
Author(s):  
Kwakye Peprah ◽  
Hannah Loshak
Keyword(s):  
Cost Effectiveness ◽  
Methadone Maintenance ◽  
Oral Morphine ◽  
Cost Effective ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Opioid Substitution Treatment ◽  
Drug Treatments ◽  
Buccal Tablets ◽  
Injectable Diacetylmorphine

There was evidence indicating that in the treatment of opioid use disorder, injectable hydromorphone, or injectable methadone provided more benefit at less cost compared with injectable diacetylmorphine over a 6-month time horizon. Evidence suggests that in the treatment of opioid use disorder, both injectable hydromorphone and injectable diacetylmorphine are likely to provide more benefit at less cost than methadone maintenance treatment. Treatment with injectable hydromorphone was more cost-effective than injectable diacetylmorphine in opioid use disorder patients who do not respond to or relapse from drug treatments. The evidence is limited because observed data were collected during a short-term follow-up, and long-term cost-effectiveness outcomes were based on extrapolations beyond data from the actual studies. One guideline provided a weak recommendation, supported by low-quality evidence, for using slow-release oral morphine in older adults with adequate renal function in whom buprenorphine and methadone maintenance have been ineffective to treat opioid use disorder or could not be tolerated. Another guideline recommends using injectable hydromorphone or injectable diacetylmorphine for individuals with severe opioid use disorders who relapsed previous treatments failed. No relevant cost-effectiveness evidence or guidelines with recommendations regarding the use of oral hydromorphone, fentanyl patches, or fentanyl buccal tablets for opioid use disorder treatment were identified; therefore, no summary can be provided.

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