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Bertin C, Bezin J, Chenaf C, Delorme J, Kerckhove N, Pariente A, Tournier M, Authier N. Oral Morphine as an Alternative Substitution Treatment for Opioid Use Disorder, a Rare but Non-risk-free Use. Front Psychiatry 2022; 13:893590. [PMID: 35845444 PMCID: PMC9282723 DOI: 10.3389/fpsyt.2022.893590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/07/2022] [Indexed: 11/26/2022] Open
Abstract
Background National health monitoring agencies have reported the alternative use of morphine sulfate painkiller for maintenance treatment of opioid use disorder (OUD), associated with a potential increase in overdose risk. Objectives This study sought to assess the prevalence of regular and occasional legally prescribed morphine use in patients treated for OUD and compare their characteristics to those of patients receiving conventional opioid maintenance treatment (OMT), buprenorphine or methadone. Then, we assessed the factors associated with opioid overdose risk. Methods Data were extracted from the French national healthcare system database, covering the entire population in 2015. Diagnosis associated with hospital discharge and long-term disease codes were extracted to select the population and identify outcomes and covariates. OUD non-chronic pain patients were divided into regular (≤35 days between dispensing and ≥3 months of continuous treatment duration) morphine users, and occasional users. Their sociodemographic and health characteristics were compared to OMT controls. A multivariate logistic regression model was performed to determine factors associated with opioid overdose. Results In patients treated for OUD, 2,237 (2.2%) morphine users (1,288 regular and 949 occasional), 64,578 (63.7%) buprenorphine and 34,638 (34.1%) methadone controls were included. The prevalence of regular morphine use among patients treated for OUD regularly receiving an opioid was 1.3%. Compared to users who receive morphine regularly, occasional users had an increased risk of overdose [OR = 2.2 (1.5-3.3)], while the risk was reduced in the buprenorphine group [OR = 0.5 (0.4-0.7)] and not significantly different for methadone [OR = 1.0 (0.7-1.4)]. Other overdose risk factors were low-income, comorbidity, i.e., psychiatric conditions, alcohol use disorder or complications related to intravenous drug use, and coprescription with benzodiazepines or pregabalin. These factors were more frequent in morphine groups. Conclusions Patients that were prescribed oral morphine represented a small minority of the treated for OUD. The poorer health condition affected by numerous comorbidities and higher risk of opioid overdose in patients treated with oral morphine compared with OMT controls points toward the need to better supervise the practices of these patients, to strengthen multidisciplinary care and risk reduction measures.
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Affiliation(s)
- Célian Bertin
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Center for Analgesic Drugs, Clermont-Ferrand, France
- Institut Analgesia, Faculté de Médecine, Clermont-Ferrand, France
| | - Julien Bezin
- Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Inserm, DRUGS-SAFE National Platform of Pharmacoepidemiology, University of Bordeaux, Bordeaux, France
- Service de Pharmacologie médicale, Pôle de Santé Publique, CHU de Bordeaux, Bordeaux, France
| | - Chouki Chenaf
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Center for Analgesic Drugs, Clermont-Ferrand, France
| | - Jessica Delorme
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Center for Analgesic Drugs, Clermont-Ferrand, France
| | - Nicolas Kerckhove
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Institut Analgesia, Faculté de Médecine, Clermont-Ferrand, France
| | - Antoine Pariente
- Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Inserm, DRUGS-SAFE National Platform of Pharmacoepidemiology, University of Bordeaux, Bordeaux, France
- Service de Pharmacologie médicale, Pôle de Santé Publique, CHU de Bordeaux, Bordeaux, France
| | - Marie Tournier
- Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, Inserm, DRUGS-SAFE National Platform of Pharmacoepidemiology, University of Bordeaux, Bordeaux, France
- Hospital Charles Perrens, Bordeaux, France
| | - Nicolas Authier
- Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107, Neuro-Dol, Service de Pharmacologie médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Clermont-Ferrand, France
- Observatoire Français des Médicaments Antalgiques (OFMA)/French Monitoring Center for Analgesic Drugs, Clermont-Ferrand, France
- Institut Analgesia, Faculté de Médecine, Clermont-Ferrand, France
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F Martins ML, Wilthagen EA, Oviedo-Joekes E, Beijnen JH, de Grave N, Uchtenhagen A, Beck T, Van den Brink W, Schinkel AH. The suitability of oral diacetylmorphine in treatment-refractory patients with heroin dependence: A scoping review. Drug Alcohol Depend 2021; 227:108984. [PMID: 34482044 DOI: 10.1016/j.drugalcdep.2021.108984] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To review the scientific literature on the pharmacokinetics, pharmacodynamics and clinical efficacy and safety of (supervised) oral diacetylmorphine for patients with severe heroin dependence. METHODS The PubMed, Embase, Web of Science and PsycINFO databases were searched. Eleven published studies were identified and selected based on defined eligibility and exclusion criteria. RESULTS Four pharmacokinetic studies reported negligible plasma concentrations of diacetylmorphine and its active metabolite 6-monacetylmorphine. Among six pharmacodynamic studies, three trials showed that oral diacetylmorphine reduced opioid withdrawal symptoms, one open-label pilot study reported that two patients experienced a modest 'rush' after oral diacetylmorphine and two studies found that patients could not distinguish between oral diacetylmorphine, methadone, or morphine. Regarding the clinical studies, a Swiss prospective cohort study in patients with heroin dependence showed high retention rates of oral diacetylmorphine treatment with few serious adverse events, whereas in the Canadian SALOME trial, oral diacetylmorphine treatment was prematurely discontinued because treatment retention of oral diacetylmorphine was lower than injectable diacetylmorphine maintenance treatment. Finally, two case studies illustrate the limitations and potential problems of oral diacetylmorphine in the treatment of treatment-refractory heroin dependent patients. CONCLUSIONS Based on all published data, it is unlikely that oral diacetylmorphine produces a substantial 'rush'. Prescription of oral diacetylmorphine might therefore be effective only for treatment-refractory patients with heroin dependence (i) as maintenance treatment for those who never injected or inhaled opioids; (ii) as maintenance treatment for those who want to switch from injection to oral administration of diacetylmorphine; and/or (iii) to reduce opioid withdrawal symptoms.
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Affiliation(s)
- Margarida L F Martins
- The Netherlands Cancer Institute, Division of Pharmacology, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
| | - Erica A Wilthagen
- The Netherlands Cancer Institute, Scientific Information Service, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
| | - Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z3, Canada; Centre for Health Evaluation & Outcome Sciences, Providence Health Care, 588 - 1081 Burrard Street, St. Paul's Hospital Vancouver, BC, V6Z 1Y6, Canada
| | - Jos H Beijnen
- The Netherlands Cancer Institute, Division of Pharmacology, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands; The Netherlands Cancer Institute, Department of Pharmacy & Pharmacology, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands; Utrecht University, Faculty of Science, Department of Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Heidelberglaan 8, 3584 CS, Utrecht, the Netherlands
| | - Nelda de Grave
- Public Health Service of Amsterdam (GGD), Nieuwe Achtergracht 100, 1018 WT, Amsterdam, the Netherlands
| | - Ambros Uchtenhagen
- Swiss Research Institute for Public Health and Addiction, Konradstrasse 32, 8005, Zurich, Switzerland
| | - Thilo Beck
- Arud Centre for Addiction Medicine, Schützengasse 3, 8001, Zurich, Switzerland
| | - Wim Van den Brink
- Central Committee on the Treatment of Heroin Addicts, Stratenum, Universiteitsweg 100, 3584 CG, Utrecht, the Netherlands; Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, 1012 WX, Amsterdam, the Netherlands
| | - Alfred H Schinkel
- The Netherlands Cancer Institute, Division of Pharmacology, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
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Mielau J, Vogel M, Gutwinski S, Mick I. New Approaches in Drug Dependence: Opioids. CURRENT ADDICTION REPORTS 2021; 8:298-305. [PMID: 34055568 PMCID: PMC8149259 DOI: 10.1007/s40429-021-00373-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 11/16/2022]
Abstract
Purpose of Review This article aims to provide an overview of standard and adjunctive treatment options in opioid dependence in consideration of therapy-refractory courses. The relevance of oral opioid substitution treatment (OST) and measures of harm reduction as well as heroin-assisted therapies are discussed alongside non-pharmacological approaches. Recent Findings Currently, recommendation can be given for OST with methadone, buprenorphine, slow-release oral morphine (SROM), and levomethadone. Heroin-assisted treatment using diamorphine shall be considered as a cost-effective alternative for individuals not responding to the afore-mentioned opioid agonists in order to increase retention and reduce illicit opioid use. The modalities of application and the additional benefits of long-acting formulations of buprenorphine should be sufficiently transferred to clinicians and the eligible patients; simultaneously methods to improve planning of actions and self- management need to be refined. Regarding common primary outcomes in research on opioid treatment, evidence of the effectiveness of adjunctive psychological interventions is scarce. Summary Maintaining a harm reduction approach in the treatment of opioid addiction, a larger range of formulations is available for the prescribers. Embedding the pharmacological, ideally individualized treatment into a holistic, structure-giving concept also requires a reduction of fragmentation of ancillary services available, drug policies, and treatment philosophies on a global scale.
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Affiliation(s)
- Juliane Mielau
- Department of Psychiatry and Psychotherapy, Psychiatric Hospital of Charité at St. Hedwig Hospital, Große Hamburger Straße 5- 11, 10115 Berlin, Germany
| | - Marc Vogel
- Department of Addictive Disorders, Psychiatric University Clinic Basel, Basel, Switzerland.,Department of Addictive Disorders, Psychiatric Services Thurgau, Muensterlingen, Switzerland
| | - Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, Psychiatric Hospital of Charité at St. Hedwig Hospital, Große Hamburger Straße 5- 11, 10115 Berlin, Germany
| | - Inge Mick
- Department of Psychiatry and Psychotherapy, Psychiatric Hospital of Charité at St. Hedwig Hospital, Große Hamburger Straße 5- 11, 10115 Berlin, Germany
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Baschirotto C, Lehmann K, Kuhn S, Reimer J, Verthein U. Switching opioid-dependent patients in substitution treatment from racemic methadone, levomethadone and buprenorphine to slow-release oral morphine: Analysis of the switching process in routine care. J Pharmacol Sci 2020; 144:9-15. [DOI: 10.1016/j.jphs.2020.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 06/05/2020] [Accepted: 06/10/2020] [Indexed: 01/15/2023] Open
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Mutua JM, Wang FB, Vaidya NK. Effects of periodic intake of drugs of abuse (morphine) on HIV dynamics: Mathematical model and analysis. Math Biosci 2020; 326:108395. [PMID: 32485213 DOI: 10.1016/j.mbs.2020.108395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 11/27/2022]
Abstract
Drugs of abuse, such as opiates, have been widely associated with diminishing host-immune responses, including suppression of HIV-specific antibody responses. In particular, periodic intake of the drugs of abuse can result in time-varying periodic antibody level within HIV-infected individuals, consequently altering the HIV dynamics. In this study, we develop a mathematical model to analyze the effects of periodic intake of morphine, a widely used opiate. We consider two routes of morphine intake, namely, intravenous morphine (IVM) and slow-release oral morphine (SROM), and integrate several morphine pharmacodynamic parameters into HIV dynamics model. Using our non-autonomous model system we formulate the infection threshold, Ri, for global stability of infection-free equilibrium, which provides a condition for avoiding viral infection in a host. We demonstrate that the infection threshold highly depends on the morphine pharmacodynamic parameters. Such information can be useful in the design of antibody-based vaccines. In addition, we also thoroughly evaluate how alteration of the antibody level due to periodic intake of morphine can affect the viral load and the CD4 count in HIV infected drug abusers.
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Affiliation(s)
- Jones M Mutua
- Department of Computer Science, Mathematics, & Physics, Missouri Western State University, St. Joseph, MO, USA
| | - Feng-Bin Wang
- Department of Natural Science in the Center for General Education, Chang Gung University, Guishan, Taoyuan 333, Taiwan; Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan
| | - Naveen K Vaidya
- Department of Mathematics and Statistics, San Diego State University, San Diego, CA, USA; Computational Science Research Center, San Diego State University, San Diego, CA, USA; Viral Information Institute, San Diego State University, San Diego, CA, USA.
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Blanco-Gandía MC, Rodríguez-Arias M. Pharmacological treatments for opiate and alcohol addiction: A historical perspective of the last 50 years. Eur J Pharmacol 2018; 836:89-101. [DOI: 10.1016/j.ejphar.2018.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 07/13/2018] [Accepted: 08/03/2018] [Indexed: 12/17/2022]
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Roux P, Mezaache S, Briand-Madrid L, Debrus M, Khatmi N, Maradan G, Protopopescu C, Rojas-Castro D, Carrieri P. Profile, risk practices and needs of people who inject morphine sulfate: Results from the ANRS-AERLI study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 59:3-9. [PMID: 29966806 DOI: 10.1016/j.drugpo.2018.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/10/2018] [Accepted: 06/11/2018] [Indexed: 11/29/2022]
Abstract
AIMS In France, a non-negligible proportion of opioid-dependent individuals inject morphine sulfate. Although it has not yet been officially approved as an opioid substitution treatment (OST), some physicians can prescribe its use for people in methadone or buprenorphine treatment failure. Longitudinal data from the ANRS-AERLI study, which evaluated an educational intervention for safer injection called AERLI, provided us the opportunity to better characterize the profile, risk practices and needs of people who inject morphine sulfate (MSI), through comparison with other injectors, and to identify correlates of HIV/HCV risk practices in this group. METHODS The national multisite ANRS-AERLI study assessed the impact of AERLI offered in volunteer harm reduction (HR) centers ("with intervention") (n = 113) through comparison with standard HR centers ("without intervention") (n = 127). All participants were scheduled to be followed up for 12 months and have 3 telephone interviews: at baseline, 6 months and 12 months. We compared MSI (n = 79) with other opioid injectors (n = 161) and then used a mixed logistic model to identify factors associated with HIV/HCV risk practices among MSI. FINDINGS Of the 240 eligible participants, 79 were regular MSI. They were less likely to use cocaine, crack or buprenorphine and to receive OST than other participants. Conversely, MSI were more likely to inject drugs more than three times a day and to report HIV/HCV risk practices. Among MSI, multivariate analysis showed that those receiving morphine sulfate as an OST were less likely to report such practices than other participants (aOR [95%CI] = 0.11 [0.02-0.61]). CONCLUSION Our results show that while MSI use fewer stimulants, they have more HIV/HCV risk practices than other injectors. However, when MSI are prescribed morphine sulfate as a treatment, these practices tend to decrease. Our findings suggest the importance of increasing access to morphine sulfate as a new OST in France.
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Affiliation(s)
- Perrine Roux
- INSERM U912 (SESSTIM), Marseille, France; Aix Marseille Université, IRD, UMR-S912, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France; GRePS (Groupe de Recherche en Psychologie Sociale) (EA4163), Université de Lyon 2, France; AIDES, Pantin, France.
| | - Salim Mezaache
- INSERM U912 (SESSTIM), Marseille, France; Aix Marseille Université, IRD, UMR-S912, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France; GRePS (Groupe de Recherche en Psychologie Sociale) (EA4163), Université de Lyon 2, France; AIDES, Pantin, France
| | - Laélia Briand-Madrid
- INSERM U912 (SESSTIM), Marseille, France; Aix Marseille Université, IRD, UMR-S912, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France; GRePS (Groupe de Recherche en Psychologie Sociale) (EA4163), Université de Lyon 2, France; AIDES, Pantin, France
| | - Marie Debrus
- Médecins du Monde, Paris, France; GRePS (Groupe de Recherche en Psychologie Sociale) (EA4163), Université de Lyon 2, France; AIDES, Pantin, France
| | - Nicolas Khatmi
- INSERM U912 (SESSTIM), Marseille, France; Aix Marseille Université, IRD, UMR-S912, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France; GRePS (Groupe de Recherche en Psychologie Sociale) (EA4163), Université de Lyon 2, France; AIDES, Pantin, France
| | - Gwenaelle Maradan
- INSERM U912 (SESSTIM), Marseille, France; Aix Marseille Université, IRD, UMR-S912, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France; GRePS (Groupe de Recherche en Psychologie Sociale) (EA4163), Université de Lyon 2, France; AIDES, Pantin, France
| | - Camélia Protopopescu
- INSERM U912 (SESSTIM), Marseille, France; Aix Marseille Université, IRD, UMR-S912, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France; GRePS (Groupe de Recherche en Psychologie Sociale) (EA4163), Université de Lyon 2, France; AIDES, Pantin, France
| | - Daniela Rojas-Castro
- Médecins du Monde, Paris, France; GRePS (Groupe de Recherche en Psychologie Sociale) (EA4163), Université de Lyon 2, France; AIDES, Pantin, France
| | - Patrizia Carrieri
- INSERM U912 (SESSTIM), Marseille, France; Aix Marseille Université, IRD, UMR-S912, Marseille, France; ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France; GRePS (Groupe de Recherche en Psychologie Sociale) (EA4163), Université de Lyon 2, France; AIDES, Pantin, France
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Metz VE, Brandt L, Unger A, Fischer G. Substance abuse/dependence treatment: a European perspective. Subst Abus 2015; 35:309-20. [PMID: 24766667 DOI: 10.1080/08897077.2014.909377] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
During the past decade, substantial progress has been made in the field of addiction medicine in Europe, particularly regarding the development of new treatment interventions, resulting in a wide range of therapeutic options for patients with substance use disorders. However, not all interventions are evidence based. Patients with cannabis and cocaine/amphetamine use disorders and special patient populations especially lack evidence-based treatment recommendations. Many patients undergo treatment that has not been scientifically evaluated for quality and efficacy. Moreover, there are large disparities regarding availability and treatment access across Europe, with the new member states of the European Union (EU) reporting long waiting lists and low treatment coverage. Even in Austria, which ranks among the countries with relatively high treatment coverage and good diversification of treatment in opioid maintenance therapy due to the availability of methadone, buprenorphine, and slow-release oral morphine (SROM), a considerable population of untreated or inadequately treated patients exists. Treatment for substance use disorders in Europe still has scope for improvement in terms of treatment availability and access, which is ideally provided by further development and implementation of evidence-based interventions.
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Affiliation(s)
- Verena E Metz
- a Department of Psychiatry and Psychotherapy , Medical University of Vienna , Vienna , Austria
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9
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Beck T, Haasen C, Verthein U, Walcher S, Schuler C, Backmund M, Ruckes C, Reimer J. Maintenance treatment for opioid dependence with slow-release oral morphine: a randomized cross-over, non-inferiority study versus methadone. Addiction 2014; 109:617-26. [PMID: 24304412 PMCID: PMC4226326 DOI: 10.1111/add.12440] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 10/11/2013] [Accepted: 11/03/2013] [Indexed: 12/01/2022]
Abstract
AIMS To compare the efficacy of slow-release oral morphine (SROM) and methadone as maintenance medication for opioid dependence in patients previously treated with methadone. DESIGN Prospective, multiple-dose, open label, randomized, non-inferiority, cross-over study over two 11-week periods. Methadone treatment was switched to SROM with flexible dosing and vice versa according to period and sequence of treatment. SETTING Fourteen out-patient addiction treatment centres in Switzerland and Germany. PARTICIPANTS Adults with opioid dependence in methadone maintenance programmes (dose ≥50 mg/day) for ≥26 weeks. MEASUREMENTS The efficacy end-point was the proportion of heroin-positive urine samples per patient and period of treatment. Each week, two urine samples were collected, randomly selected and analysed for 6-monoacetyl-morphine and 6-acetylcodeine. Non-inferiority was concluded if the two-sided 95% confidence interval (CI) in the difference of proportions of positive urine samples was below the predefined boundary of 10%. FINDINGS One hundred and fifty-seven patients fulfilled criteria to form the per protocol population. The proportion of heroin-positive urine samples under SROM treatment (0.20) was non-inferior to the proportion under methadone treatment (0.15) (least-squares mean difference 0.05; 95% CI = 0.02, 0.08; P > 0.01). The 95% CI fell within the 10% non-inferiority margin, confirming the non-inferiority of SROM to methadone. A dose-dependent effect was shown for SROM (i.e. decreasing proportions of heroin-positive urine samples with increasing SROM doses). Retention in treatment showed no significant differences between treatments (period 1/period 2: SROM: 88.7%/82.1%, methadone: 91.1%/88.0%; period 1: P = 0.50, period 2: P = 0.19). Overall, safety outcomes were similar between the two groups. CONCLUSIONS Slow-release oral morphine appears to be at least as effective as methadone in treating people with opioid use disorder.
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Affiliation(s)
- Thilo Beck
- Arud Centres for Addiction MedicineZurich, Switzerland,Correspondence to: Thilo Beck, Arud Zurich, Konradstrasse 32, 8005 Zurich, Switzerland. E-mail:
| | - Christian Haasen
- Centre for Interdisciplinary Addiction Research of Hamburg University, Department of Psychiatry, University Medical Centre EppendorfHamburg, Germany
| | - Uwe Verthein
- Centre for Interdisciplinary Addiction Research of Hamburg University, Department of Psychiatry, University Medical Centre EppendorfHamburg, Germany
| | | | | | - Markus Backmund
- Praxiszentrum im TalMunich, Germany,Ludwig-Maximilians-UniversitätMunich, Germany
| | - Christian Ruckes
- Interdisciplinary Centre for Clinical Trials (IZKS), University Medical Centre of the Johannes Gutenberg University MainzMainz, Germany
| | - Jens Reimer
- Centre for Interdisciplinary Addiction Research of Hamburg University, Department of Psychiatry, University Medical Centre EppendorfHamburg, Germany
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Viswanath B, Chand P, Benegal V, Murthy P. Agonist treatment in opioid use: advances and controversy. Asian J Psychiatr 2012; 5:125-31. [PMID: 22813654 DOI: 10.1016/j.ajp.2012.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 01/12/2012] [Accepted: 01/19/2012] [Indexed: 10/28/2022]
Abstract
Opioid dependence is a chronic relapsing condition which requires comprehensive care; pharmacological agents form the mainstay of its long term treatment. The two most popular approaches are the harm reduction method using agonists and the complete abstinence method using antagonists. Currently, particularly from the harm minimization perspective and the low feasibility of an abstinence based approach, there is an increasing trend toward agonist treatment. The use of buprenorphine has gained popularity in view of its safety profile and the availability of the buprenorphine-naloxone combination has made it popular as a take-home treatment. This review outlines the pharmacological advances and controversies in this area.
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Affiliation(s)
- Biju Viswanath
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560 029, India.
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11
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Colom Farran J, Casas M, Pérez de Los Cobos J, Del Río M, Roncero C, Castells X, Valero S, Eiroa-Orosa FJ, Batlle F, Trujols J. Feasibility of double-blind clinical trials with oral diacetylmorphine: a randomized controlled phase II study in an inpatient setting. Eur Addict Res 2012; 18:279-87. [PMID: 22854605 DOI: 10.1159/000336849] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Accepted: 01/25/2012] [Indexed: 11/19/2022]
Abstract
The aim of this study was to evaluate the feasibility of conducting double-blind controlled randomized clinical trials using twice-a-day immediate-release oral diacetylmorphine (DAM) in heroin-dependent patients, by means of measuring the capacity of oral DAM to block opiate withdrawal and clinicians' ability to distinguish it from morphine and methadone. This was a randomized, phase II, double-blind, multicenter pilot study comparing immediate-release oral DAM, slow-release oral morphine and oral methadone administered twice a day during 10 days. Forty-five heroin-dependent patients were randomly assigned to these three treatment groups in an inpatient regime. Patients were stabilized with a mean of 350 mg (SD = 193) of immediate-release oral DAM, 108 mg (SD = 46.2) of slow-release oral morphine and 40 mg (SD = 17.9) of methadone. No statistically significant differences were found between any studied medication in clinical outcome. Neither patients nor clinicians were able to identify the administered medication. This study shows the feasibility of double-blind clinical trials using b.i.d. immediate-release oral DAM allowing further phase III clinical trials in the process of introducing oral DAM as a medication for heroin-dependent patients not responding to standard maintenance treatments.
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Affiliation(s)
- Joan Colom Farran
- Programme on Substance Abuse, Public Health Agency of Catalonia, Government of Catalonia, Barcelona, Spain.
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Rao R, Ambekar A, Yadav S, Sethi H, Dhawan A. Slow-release oral morphine as a maintenance agent in opioid dependence syndrome: an exploratory study from India. JOURNAL OF SUBSTANCE USE 2011. [DOI: 10.3109/14659891.2011.583310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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BOND ALYSONJ, REED KYLIED, BEAVAN PETE, STRANG JOHN. After the randomised injectable opiate treatment trial: Post-trial investigation of slow-release oral morphine as an alternative opiate maintenance medication. Drug Alcohol Rev 2011; 31:492-8. [DOI: 10.1111/j.1465-3362.2011.00353.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jegu J, Gallini A, Soler P, Montastruc JL, Lapeyre-Mestre M. Slow-release oral morphine for opioid maintenance treatment: a systematic review. Br J Clin Pharmacol 2011; 71:832-43. [PMID: 21265874 PMCID: PMC3099370 DOI: 10.1111/j.1365-2125.2011.03923.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Accepted: 01/18/2011] [Indexed: 11/29/2022] Open
Abstract
This review article summarizes the results of all available clinical trials considering the use of slow-release oral morphine (SROM) for opioid maintenance treatment (OMT). All studies published up to October 2010 and assessing SROM for OMT in adult patients are included. Three independent reviewers assessed the selected articles using a standardized checklist. Study design, study length and number of subjects included were recorded. Data about retention rate (proportion of participants remaining under maintenance treatment at the end of the study), quality of life, withdrawal symptoms, craving, additional drug consumption, driving capacity and adverse events were collected. We identified 13 articles corresponding to nine clinical trials considering the use of SROM for OMT. Among them, only one was a randomized trial and one was a controlled not randomized trial. All other studies were uncontrolled. Retention rates were good (from 80.6 to 95%) with SROM maintenance, but similar retention rates were obtained with methadone. Most of the studies showed that quality of life, withdrawal symptoms, craving and additional drug consumption improved with SROM. However, there was no comparison with other maintenance drugs. As most of the studies assessing SROM efficacy were uncontrolled, there is no definite evidence that SROM is an effective alternative to methadone for OMT.
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Affiliation(s)
- Jeremie Jegu
- Department of Medical and Clinical Pharmacology, Centre d'Evaluation et d'Information sur Pharmacodépendance Addictovigilance, University Hospital of Toulouse, 31000 Toulouse, France.
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Fischer M, Reimer J, Schäfer I, Haasen C. Zum Stand der Substitutionstherapie in Deutschland. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010; 53:332-9. [DOI: 10.1007/s00103-010-1030-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Wurm M, Woess C, Libiseller K, Beer B, Pavlic M. Challenging Small Human Hepatocytes with Opiates: Further Characterization of a Novel Prototype Bioartificial Liver. Tissue Eng Part A 2010; 16:807-13. [DOI: 10.1089/ten.tea.2009.0420] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Martin Wurm
- Department of General and Transplant Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Claudia Woess
- Institute of Legal Medicine, Innsbruck Medical University, Innsbruck, Austria
| | - Kathrin Libiseller
- Institute of Legal Medicine, Innsbruck Medical University, Innsbruck, Austria
| | - Beate Beer
- Institute of Legal Medicine, Innsbruck Medical University, Innsbruck, Austria
| | - Marion Pavlic
- Institute of Legal Medicine, Innsbruck Medical University, Innsbruck, Austria
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Unger A, Martin P, Kaltenbach K, Stine S, Heil S, Jones H, Arria A, Coyle M, Selby P, Fischer G. Clinical Characteristics of Central European and North American Samples of Pregnant Women Screened for Opioid Agonist Treatment. Eur Addict Res 2010; 16:99-107. [PMID: 20160444 PMCID: PMC2917735 DOI: 10.1159/000284683] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Little comparable information is available regarding clinical characteristics of opioid-dependent women from different countries. In the present study, women from the USA, Canada and a Central European country, Austria, screened for participation in the Maternal Opioid Treatment Human Experimental Research study, were compared with respect to their demographic and addiction histories. METHODS Pregnant women (n = 1,074) were screened for study participation using uniformed clinical criteria and instruments. The screening results were compared with regard to exclusion, demographics, drug use, and psychosocial and treatment histories. RESULTS Compared to the screened US and Canadian women, Austrian women were more likely to be younger (p < 0.001), white (p < 0.001), had significantly lower levels of educational attainment (p < 0.001), were less likely to use opioids daily (p < 0.001) and more likely to have been prescribed buprenorphine (p < 0.001). Compared to both rural and urban US groups, the Austrian group was less likely to have legal issues (p < 0.001) and was younger when first prescribed agonist medication (p < 0.001). CONCLUSION The differences between North American and European groups may offer unique insights concerning treatment and pregnancy outcomes for opioid-dependent pregnant women.
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Affiliation(s)
- A.S. Unger
- *Annemarie S. Unger, University Hospital of Vienna, Department of Psychiatry, Währinger Gürtel 18–20, AT–1090 Vienna (Austria), Tel. +43 1 40400 3547, Fax +43 1 40400 3388, E-Mail
| | - P.R. Martin
- Department of Psychiatry, University Hospital of Vienna, Vienna, Austria
| | - K. Kaltenbach
- Department of Psychiatry, University Hospital of Vienna, Vienna, Austria
| | - S.M. Stine
- Department of Psychiatry, University Hospital of Vienna, Vienna, Austria
| | - S.H. Heil
- Department of Psychiatry, University Hospital of Vienna, Vienna, Austria
| | - H.E. Jones
- Department of Psychiatry, University Hospital of Vienna, Vienna, Austria
| | - A.M. Arria
- Department of Psychiatry, University Hospital of Vienna, Vienna, Austria
| | - M.G. Coyle
- Department of Psychiatry, University Hospital of Vienna, Vienna, Austria
| | - P. Selby
- Department of Psychiatry, University Hospital of Vienna, Vienna, Austria
| | - G. Fischer
- Department of Psychiatry, University Hospital of Vienna, Vienna, Austria
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Oviedo-Joekes E, Nosyk B, Marsh DC, Guh D, Brissette S, Gartry C, Krausz M, Anis A, Schechter MT. Scientific and political challenges in North America's first randomized controlled trial of heroin-assisted treatment for severe heroin addiction: rationale and design of the NAOMI study. Clin Trials 2009; 6:261-71. [PMID: 19528135 PMCID: PMC5127700 DOI: 10.1177/1740774509105222] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Heroin addiction is a chronic relapsing disease, best treated with opioid-agonist substitution therapy such as methadone maintenance. However, a subset of the most severely affected individuals do not benefit sufficiently from this treatment. The North American Opiate Medication Initiative (NAOMI) is a randomized clinical trial (RCT) to evaluate the hypothesis that pharmaceutical-grade heroin, diacetylmorphine (DAM) is more effective in retaining patients and improving their outcomes than Methadone Maintenance Treatment (MMT) among those with chronic, refractory injection opioid dependence. PURPOSE/METHODS The study aimed at randomizing 253 participants to two intervention arms: (1) MMT alone or (2) injectable opioids (DAM or hydromorphone) plus adjunctive MMT if deemed appropriate. The planned study duration was 3 years, with a 1-year intake period, 1 year of treatment, and an additional year of follow-up. The NAOMI trial was initiated in March 2005 at two Canadian sites (Vancouver and Montreal). This was the first multicenter RCT in North America to compare the relative efficacy of these different therapeutic strategies. We discuss the rationale behind the NAOMI study design, as well as the scientific and political issues and methodological challenges arising from the conduct of a trial that involves the prescription of a controlled substance to individuals with dependence on that substance. LIMITATIONS Restrictive entry criteria led to the exclusion of many otherwise eligible participants, slowing recruitment into the study. Inability to offer DAM treatment beyond 12 months led to artificial boundary effects in the trial. CONCLUSIONS Addiction treatment research navigates between science and politics, and evidence-based medicine is many times confronted by moral beliefs. Political considerations influence study design to a further degree than in RCTs treating less-stigmatized disorders with more-reputable medications.
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Affiliation(s)
- Eugenia Oviedo-Joekes
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
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Winklbaur B, Kopf N, Ebner N, Jung E, Thau K, Fischer G. Treating pregnant women dependent on opioids is not the same as treating pregnancy and opioid dependence: a knowledge synthesis for better treatment for women and neonates. Addiction 2008; 103:1429-40. [PMID: 18783498 DOI: 10.1111/j.1360-0443.2008.02283.x] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Through a novel synthesis of the literature and our own clinical experience, we have derived a set of evidence-based recommendations for consideration as guidance in the management of opioid-dependent pregnant women and infants. METHODS PubMed literature searches were carried out to identify recent key publications in the areas of pregnancy and opioid dependence, neonatal abstinence syndrome (NAS) prevention and treatment, multiple substance abuse and psychiatric comorbidity. RESULTS Pregnant women dependent on opioids require careful treatment to minimize harm to the fetus and neonate and improve maternal health. Applying multi-disciplinary treatment as early as possible, allowing medication maintenance and regular monitoring, benefits mother and child both in the short and the long term. However, there is a need for randomized clinical trials with sufficient sample sizes. RECOMMENDATIONS Opioid maintenance therapy is the recommended treatment approach during pregnancy. Treatment decisions must encompass the full clinical picture, with respect to frequent complications arising from psychiatric comorbidities and the concomitant consumption of other drugs. In addition to standardized approaches to pregnancy, equivalent attention must be given to the treatment of NAS, which occurs frequently after opioid medication. CONCLUSION Methodological flaws and inconsistencies confound interpretation of today's literature. Based on this synthesis of available evidence and our clinical experience, we propose recommendations for further discussion.
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Affiliation(s)
- Bernadette Winklbaur
- Department of Psychiatry and Psychotherapy, Medical University Vienna, Waehringergurtel 18-20, Vienna, Austria
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Aeschbach Jachmann C, Jagsch R, Winklbaur B, Matzenauer C, Fischer G. Office-based treatment in opioid dependence: a critical survey of prescription practices for opioid maintenance medications and concomitant benzodiazepines in Vienna, Austria. Eur Addict Res 2008; 14:206-12. [PMID: 18583918 DOI: 10.1159/000141645] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The success of maintenance treatment for opioid dependence in office-based settings is influenced by the extent of treatment coverage, the availability of effective medications and the capacity of general practitioners to prescribe opioids in adequate doses with a minimum of concomitant benzodiazepine prescriptions. METHODS This study compares prescriptions for opioid maintenance and concomitant benzodiazepine from Viennese physicians in 2002 and 2005 using health insurance prescription records (n = 30,309). RESULTS Between 2002 and 2005, the number of patients prescribed opioids more than doubled (ratio 1:2.3), slow-release oral morphine replaced methadone as the most frequently prescribed medication (57.1 vs. 23.4%; buprenorphine 19.5%), and the ratio of benzodiazepine to opioid prescriptions significantly declined (0.76:1 vs. 0.42:1). Many patients were prescribed concomitant benzodiazepines (27%), in some cases from a secondary physician. CONCLUSION Increased utilization of opioid medications in office-based settings will facilitate better treatment coverage. However, safeguards are necessary to ensure that general practitioners have sufficient training and support to safely and appropriately provide treatment, including the reduction in concomitant benzodiazepine use.
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Roncero Alonso C, Sáez Francàs N, Castells Cervelló X, Casas Brugué M. Tratamiento con morfina en la dependencia de opiáceos. Rev Clin Esp 2007; 207:194-6. [PMID: 17475184 DOI: 10.1157/13101850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Morphine is an opiate drug widely used as an analgesic in multiple medical diseases. Currently, its management in the maintenance treatment of opiate dependent patients is being studied. The most significant studies are described. In these, its usefulness has been assessed in comparison with other treatments, such as methadone, buprenorphine. Morphine has shown efficacy and tolerability. Its management is easy both in patients who consume heroin as well as those who have received other opiate drugs. Thus, it is a drug that may extend the therapeutic armamentarium in patients who begin with treatment with other opiates for the first time or who have previously received them. However, new studies must be conducted to adequately characterize its clinical use.
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Affiliation(s)
- C Roncero Alonso
- Servicio de Psiquiatría, Hospital Universitario Valle Hebrón, Universidad Autónoma de Barcelona, Paseo Vall d'Hebron 119-129, 08025 Barcelona, Spain
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Abstract
This paper is the 28th consecutive installment of the annual review of research concerning the endogenous opioid system, now spanning over a quarter-century of research. It summarizes papers published during 2005 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides, opioid receptors, opioid agonists and opioid antagonists. The particular topics that continue to be covered include the molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors related to behavior (Section 2), and the roles of these opioid peptides and receptors in pain and analgesia (Section 3); stress and social status (Section 4); tolerance and dependence (Section 5); learning and memory (Section 6); eating and drinking (Section 7); alcohol and drugs of abuse (Section 8); sexual activity and hormones, pregnancy, development and endocrinology (Section 9); mental illness and mood (Section 10); seizures and neurologic disorders (Section 11); electrical-related activity, neurophysiology and transmitter release (Section 12); general activity and locomotion (Section 13); gastrointestinal, renal and hepatic functions (Section 14); cardiovascular responses (Section 15); respiration and thermoregulation (Section 16); immunological responses (Section 17).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, 65-30 Kissena Blvd., Flushing, NY 11367, USA.
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Abstract
PURPOSE OF REVIEW To provide an overview of published studies on agonist maintenance treatment options for opioid-dependent patients. RECENT FINDINGS The recent publication of controlled trials confirms earlier clinical evidence of the efficacy of diamorphine (heroin) in the treatment of opioid dependence. Findings show not only efficacy with respect to improvement of health, reduction of illicit drug use, reduction of criminality and stabilization of social conditions, but also cost effectiveness in the treatment of chronic treatment-resistant heroin addicts. SUMMARY Agonist maintenance treatment has become the first-line treatment for chronic opioid dependence. High-quality studies demonstrate the effectiveness of a growing number of different agonist maintenance treatments for opioid dependence such as methadone and buprenorphine. In addition, there is new evidence for the effectiveness of other agonists, mainly slow-release morphine, intravenous and inhalable diamorphine and possibly oral diamorphine. Maintenance treatment with intravenous or inhalable diamorphine should be implemented into the healthcare system to treat a group of severely dependent treatment-resistant patients. Furthermore, the opioid-dependent patients not under treatment need to be engaged in maintenance treatments through other harm reduction measures. Agonist maintenance treatment is very effective in stabilizing the health condition and social situation, while also reducing harm, thereby increasing life expectancy and quality of life.
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Affiliation(s)
- Christian Haasen
- Department of Psychiatry, University Medical Center Eppendorf, Center for Interdisciplinary Addiction Research, Hamburg, Germany.
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Van den Brink W, Haasen C. Evidenced-based treatment of opioid-dependent patients. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2006; 51:635-46. [PMID: 17052031 DOI: 10.1177/070674370605101003] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To provide an overview of treatment options for opioid-dependent patients. METHOD We screened all published studies on the treatment of opioid dependence, with a special focus on systematic literature reviews, formal metaanalyses, and recent trials. RESULTS Both clinical experience and neurobiological evidence indicate that opioid dependence is a chronic relapsing disorder. Treatment objectives depend on the pursued goals: crisis intervention, abstinence-oriented treatment (detoxification and relapse prevention), or agonist maintenance treatment. The high quality of solid evidence in the literature demonstrates that there are numerous effective interventions available for the treatment of opioid dependence. Crisis intervention, frequently necessary owing to the high overdose rate, can be effectively handled with naloxone. Abstinence-oriented interventions are effective for only a few motivated patients with stable living conditions and adequate social support. Agonist maintenance treatment is considered the first line of treatment for opioid dependence. Numerous studies have shown efficacy for methadone and buprenorphine treatment, while maintenance with other agonists is also becoming available to a greater extent. Maintenance treatment with diamorphine should be made available for the small group of treatment-resistant, severely dependent addicts. Other harm-reduction measures can serve to engage individuals with opioid addiction who are not in treatment. CONCLUSION Opioid dependence is a chronic relapsing disease that is difficult to cure, but effective treatments are available to stabilize patients and reduce harm, thereby increasing life expectancy and quality of life.
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Affiliation(s)
- Wim Van den Brink
- Academic Medical Center, University of Amsterdam, Department of Psychiatry, The Netherlands.
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Substanzabhängigkeit vom Morphintyp – State-of-the-Art der Erhaltungstherapie mit synthetischen Opioiden. ACTA ACUST UNITED AC 2006. [DOI: 10.1007/s11326-006-0022-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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