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

Kraigher, D.; Jagsch, Reinhold; Gombas, Wolfgang; Ortner, R.; Eder, Harald; Primorac, Andjela; Fischer, Gabriele

doi:10.1159/000085550

Cited by 45 publications

(21 citation statements)

References 47 publications

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“…At the same time, a significantly lower percentage of urban US and Canadian women had never been prescribed either drug compared to Austrian women. This discrepancy may have resulted be-cause many of the Austrian women who had never received methadone or buprenorphine had been treated with slow-release oral morphine, which for the indication of opioid maintenance treatment is only approved in some European countries, among them Austria [19][20][21][22] . The use of slow-release oral morphine was not assessed in the present study.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics of Central European and North American Samples of Pregnant Women Screened for Opioid Agonist Treatment

et al. 2010

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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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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics of Central European and North American Samples of Pregnant Women Screened for Opioid Agonist Treatment

et al. 2010

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“…Although medication choice facilitates individualized treatment, these choices require adequate training of prescribing doctors [6] and support by research evidence. From our data, the factors contributing to a significant increase in SROM prescriptions between 2002 and 2005 are difficult to ascertain.…”

Section: Discussionmentioning

confidence: 99%

“…However, large clinical evaluations of SROM have yet to be undertaken. In Austria, it has been legal to use oral methadone in the treatment of opioid dependence since 1987 [22] , with SROM and buprenorphine registered for use in 1998 [6] and 1999 [5] , respectively. Suboxone has been available in Austria and offered by the Insurance Agency of Vienna since February 1, 2008.…”

Section: Flexibility Of Treatmentmentioning

confidence: 99%

“…Several medications are widely used for maintenance treatment, including full -receptor agonists, e.g. oral methadone and slow-release oral morphine (SROM), and the partial -receptor agonist and -receptor antagonist, buprenorphine [5,6] . Although maintenance therapy is available in most countries in the world, the readiness with which these can be accessed and the choice of medications available vary between countries [7] .…”

Section: Introductionmentioning

confidence: 99%

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Office-Based Treatment in Opioid Dependence: A Critical Survey of Prescription Practices for Opioid Maintenance Medications and Concomitant Benzodiazepines in Vienna, Austria

Jachmann

Jagsch²,

Winklbaur³

et al. 2008

Eur Addict Res

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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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“…HIV, hepatitis B and C, and tuberculosis), various European countries have begun to consider alternative treatments [4], namely oral slow-release morphine [22,23,24], and parenteral diacetylmorphine (DAM) [25,26,27]. …”

Section: Introductionmentioning

confidence: 99%

Feasibility of Double-Blind Clinical Trials with Oral Diacetylmorphine: A Randomized Controlled Phase II Study in an Inpatient Setting

Farran

Casas²,

Cobos³

et al. 2012

Eur Addict Res

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

Cited by 45 publications

References 47 publications

Clinical Characteristics of Central European and North American Samples of Pregnant Women Screened for Opioid Agonist Treatment

Clinical Characteristics of Central European and North American Samples of Pregnant Women Screened for Opioid Agonist Treatment

Office-Based Treatment in Opioid Dependence: A Critical Survey of Prescription Practices for Opioid Maintenance Medications and Concomitant Benzodiazepines in Vienna, Austria

Feasibility of Double-Blind Clinical Trials with Oral Diacetylmorphine: A Randomized Controlled Phase II Study in an Inpatient Setting

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