Slow-release oral morphine versus methadone: a crossover comparison of patient outcomes and acceptability as maintenance pharmacotherapies for opioid dependence.
OBJECTIVE
To evaluate slow-release oral morphine (SROM) as an alternative maintenance pharmacotherapy to methadone for treatment of opioid dependence.


METHODS
Open-label crossover study.


METHODS
Out-patient methadone maintenance programme.


METHODS
Eighteen methadone maintenance patients. Intervention Participants were transferred from methadone to SROM (once-daily Kapanol trade mark ) for approximately 6 weeks before resuming methadone maintenance.


METHODS
Patient outcomes were assessed (1) during the transition between medications (dose requirements, withdrawal severity) and (2) after at least 4 weeks on a stable dose of each drug (treatment preference, patient ratings of treatment efficacy and acceptability, drug use, health, depression and sleep).


RESULTS
Transfer from methadone to SROM was associated with relatively mild withdrawal for the first 5 days; the final mean SROM : methadone dose ratio was 4.6 : 1. Compared to methadone, SROM was associated with improved social functioning, weight loss, fewer and less troublesome side-effects, greater drug liking, reduced heroin craving, an enhanced sense of feeling 'normal' and similar outcomes for unsanctioned drug use, depression and health. The majority of subjects preferred SROM (78%) over methadone (22%).


CONCLUSIONS
These findings provide justification for further evaluation of SROM as a maintenance pharmacotherapy for opioid dependence.
Mitchell
Timothy B
TB
Department of Clinical and Experimental Pharmacology, University of Adelaide, Adelaide, South Australia, 5005, Australia. t.mitchell@iop.kcl.ac.uk
White
Jason M
JM
Somogyi
Andrew A
AA
Bochner
Felix
F
D000328:Adult; D018592:Cross-Over Studies; D003692:Delayed-Action Preparations; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage*; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D009294:Narcotics / Q000008:administration & dosage*; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D017060:Patient Satisfaction; D016896:Treatment Outcome
D003692:Delayed-Action Preparations; D009294:Narcotics; D009020:Morphine; D008691:Methadone