title: Mental symptoms and drug use in maintenance treatment with slow-release oral morphine compared to methadone: results of a randomized crossover study.
abstract: BACKGROUND
  Opioid maintenance treatment is the option of choice to stabilize opioid-dependent patients. Whilst efficacy of methadone and buprenorphine has been studied extensively, fewer data on slow-release oral morphine are available.
  
  
  OBJECTIVE
  This study analyzes the effects of slow-release oral morphine compared to methadone with regard to self-reported mental symptoms, drug use and satisfaction with treatment.
  
  
  METHODS
  The study was carried out as an open-label randomized crossover trial in 14 treatment sites in Switzerland and Germany. It comprised 2 crossover periods of 11 weeks each. For measuring mental symptoms, the Symptom Checklist-27 (SCL-27) was used. Drug and alcohol use was assessed by the number of consumption days, and treatment satisfaction by a visual analogue scale.
  
  
  RESULTS
  A total of 157 patients were included for the analyses (per-protocol sample). Statistically significantly better outcomes for morphine as compared to methadone treatment were found for overall severity of mental symptoms (SCL-27 Global Severity Index), as well as 5 of the 6 syndrome groups of the SCL-27, and for treatment satisfaction. There were no statistically significant differences with regard to drug or alcohol use between groups.
  
  
  CONCLUSIONS
  This study supports positive effects of slow-release oral morphine compared to methadone on patient-reported outcomes such as mental symptoms and treatment satisfaction with comparable effects on concomitant drug use. Slow-release oral morphine represents a meaningful alternative to methadone for treatment of opioid dependence.
authors.affiliation: Centre for Interdisciplinary Addiction Research of Hamburg University, Hamburg, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Verthein
authors.forename: Thilo
authors.initials: T
authors.lastname: Beck
authors.forename: Christian
authors.initials: C
authors.lastname: Haasen
authors.forename: Jens
authors.initials: J
authors.lastname: Reimer
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000428:Alcohol Drinking; D001526:Behavioral Symptoms / Q000188:drug therapy*; D018592:Cross-Over Studies; D003692:Delayed-Action Preparations; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage* / Q000627:therapeutic use*; D009020:Morphine / Q000008:administration & dosage* / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D017060:Patient Satisfaction; D019966:Substance-Related Disorders; D013557:Switzerland; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D003692:Delayed-Action Preparations; D009294:Narcotics; D009020:Morphine; D008691:Methadone