Slow‐release oral morphine for opioid maintenance treatment: a systematic review

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.

Management of opioid use disorders: a national clinical practice guideline

“…Considering the wide range of doses described in the literature, 65 we suggest that practitioners holding a federal exemption with no prior experience in prescribing slow-release oral morphine for opioid agonist treatment also consult with a specialist. As is the case with methadone, because of patient and public safety risks associated with slow-release oral morphine diversion, the committee suggests that the standard should be to prescribe slow-release oral morphine as daily witnessed doses.…”

Slow-Release Oral Morphine Sulfate Abuse: Results of the Postmarketing Surveillance Systems for Psychoactive Prescription Drug Abuse in France

“…Moreover, overlap of two prescription forms is forbidden. Slow-release oral morphine sulfate (SROM) is now available as opioid maintenance therapy (OMT) in some European countries (Austria, Slovakia, Slovenia, Bulgaria, and Luxembourg), but not in France, where this prescription for OMT is off-labeled because of the lack of evidence showing that SROM is an effective alternative to methadone for OMT [6,7]. However, SROM can be prescribed in exceptional cases of intolerance or inefficacy of methadone or buprenorphine, as indicated by a note from the French General Directorate of Health in June 1996.…”

International Expansion of the Use of Pharmacotherapies for the Treatment of Opioid Dependence

“…Slow release morphine: Bulgaria, France, Italy, Luxemburg, Netherlands, Austria, Slovenia, and the United Kingdom allow treatment using slow release oral morphine (SROM) [91]. The use of SROM for maintenance treatment, however, remains controversial and scarcely studied.…”

“…The use of SROM for maintenance treatment, however, remains controversial and scarcely studied. A recent literature review of the available clinical trials on the use of SROM concluded that there was currently no definite evidence showing that SROM is an effective alternate to methadone for opioid maintenance treatment [91].…”

“…These medications have shown efficacy only in clinical trials. Other treatment paradigms shown in pilot clinical trials include the use of slow-release oral morphine (Substitol ® ) [44], hydromorphone and diacetylmorphine [45]. Heroin-assisted treatment programs have been studied in Austria, Belgium, Canada, France, Germany, Spain, Switzerland, the United Kingdom and the Netherlands [46].…”