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Home > Slow release oral morphine as maintenance therapy for opioid dependence.

Ferri, Marica and Minozzi, Silvia and Bo, Alessandra and Amato, Laura [The Cochrane Library] . (2013) Slow release oral morphine as maintenance therapy for opioid dependence. London: John Wiley & Sons, Ltd. Cochrane Database of Systematic Reviews (6) Art. No.: CD009879. DOI: 10.1002/14651858.CD009879.pub2.

URL: http://onlinelibrary.wiley.com/doi/10.1002/1465185...

pioid dependence is associated with public health and social problems. People injecting opioids are particularly at risk, not only because they become dependent faster than with other routes of administration but also because they are exposed to consequences such as an increased risk of overdose mortality, infective diseases and health issues. At least three-quarters of global opiate users consume heroin.

Opioid substitution treatment involves prescribing an opioid to replace street heroin or other opioids. This is a long-term treatment that has been shown to reduce injecting of street heroin and the risk of death and blood-borne virus transmission, and to reduce involvement in crime.

Maintenance treatments that are effective in retaining people in treatment and suppressing heroin use include methadone, buprenorphine, and dyacethilmorphine, alone or combined with psychosocial treatments. In order to diversify the treatment possibilities, it is important to clarify the benefits that each specific intervention can bring to patients. Slow release oral morphine (SROM) is given once daily and has been proposed for people who cannot tolerate methadone or who respond poorly to other available maintenance treatments.

This review did not identify sufficient evidence to assess the effectiveness of SROM for opioid maintenance. Only three randomised controlled trials involving 195 participants met our inclusion criteria. The findings of two studies suggested a possible reduction of opioid use in people taking SROM. In another study, the use of SROM was associated with fewer depressive symptoms. Retention in treatment was not clearly different among the compared interventions. Adverse effects were more frequent with SROM than buprenorphine or methadone, including stomach cramps, headache, toothache, constipation, vomiting and insomnia.

These studies had small numbers of participants, very short follow -up and were designed to answer different questions. Overall, the quality of the evidence can be judged as low.


Item Type
Evidence resource
Publication Type
Review
Drug Type
Opioid
Intervention Type
AOD disorder treatment method, AOD disorder drug therapy
Date
June 2013
Publisher
John Wiley & Sons, Ltd
Place of Publication
London
Number
6
EndNote
Accession Number
HRB (Not in collection)

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