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  • Title: After the randomised injectable opiate treatment trial: post-trial investigation of slow-release oral morphine as an alternative opiate maintenance medication.
    Author: Bond AJ, Reed KD, Beavan P, Strang J.
    Journal: Drug Alcohol Rev; 2012 Jun; 31(4):492-8. PubMed ID: 21919979.
    Abstract:
    INTRODUCTION AND AIMS: To establish if slow-release oral morphine (SROM) is an acceptable maintenance medication in heroin users currently being prescribed injectable diamorphine, who are intolerant to supplementary methadone. DESIGN AND METHODS: Case note review of interviews and medication details before and after change in medication in 12 treatment-resistant chronic heroin users attending a supervised injecting clinic twice a day for prescribed injectable diamorphine plus supplementary oral methadone to ensure 24 h stability. SROM was substituted for oral methadone by cross-titration. The patients' experiences of methadone treatment and expectations of SROM were recorded before the switch. Their responses to SROM and changes in injectable diamorphine requirements were recorded after a mean of 10 weeks' SROM treatment. RESULTS: The patients described a dislike and intolerance of methadone but had positive expectations of SROM which they believed would allow them to reduce their diamorphine dose. The mean stable methadone : SROM maintenance dose ratio was 1:7.5. After 10 weeks' SROM treatment, the average daily diamorphine dose reduced from 382 mg to 315 mg and patients reported fewer cravings and improved sleep and well-being. DISCUSSION AND CONCLUSIONS: Alternative forms of maintenance medication are required for patients who are intolerant to methadone. SROM is a valuable alternative which enabled some patients to reduce both their dose and number of injections of diamorphine. SROM treatment may therefore represent a route to stop injecting.
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