Safety of injectable opioid maintenance treatment for heroin dependence.
BACKGROUND
There is a growing debate about injectable opioid treatment programs in many Western countries. This is the first placebo-controlled study of the safety of injectable opioids in a controlled treatment setting.


METHODS
Twenty-five opioid-dependent patients on intravenous (IV) heroin or IV methadone maintenance treatment were randomly assigned to either their individual prescribed IV maintenance dose or placebo. Acute drug effects were recorded, focusing on electrocardiography, respiratory movements, arterial blood oxygen saturation, and electroencephalography (EEG).


RESULTS
After heroin injection, marked respiratory depression progressing to a Cheyne-Stokes pattern occurred. Peripheral arterial blood oxygenation decreased to 78.9 +/- 8.7% (mean +/- SD) ranging from 52%-90%. During hypoxia, 7 of the 16 subjects experienced intermittent and somewhat severe bradycardia. Five subjects exhibited paroxysmal EEG patterns. After methadone injection, respiratory depression was less pronounced than after heroin injection. No relevant bradycardia was noted.


CONCLUSIONS
Opioid doses commonly prescribed in IV opioid treatment induce marked respiratory and circulatory depression, as well as occasionally irregular paroxysmal EEG activity. Further studies are needed to optimize the clinical practice of IV opioid treatment to prevent serious complications. Moreover, the extent of the observed effects raises questions about the appropriateness of IV opioid treatment in the present form.
Stoermer
Robert
R
Center of Applied Technologies in Neuroscience-Basel, Psychiatric University Clinic of Basel, Wilhelm Klein-Strasse 27, 4025 Basel, Switzerland.
Drewe
Juergen
J
Dursteler-Mac Farland
Kenneth M
KM
Hock
Christoph
C
Mueller-Spahn
Franz
F
Ladewig
Dieter
D
Stohler
Rudolf
R
Mager
Ralph
R
D000328:Adult; D001919:Bradycardia / Q000139:chemically induced*; D004569:Electroencephalography / Q000187:drug effects; D005260:Female; D006556:Heroin Dependence / Q000534:rehabilitation*; D006801:Humans; D000860:Hypoxia / Q000139:chemically induced*; D007275:Injections, Intravenous; D008297:Male; D008691:Methadone / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use
D009294:Narcotics; D008691:Methadone