Slow-Release Oral Morphine May Help Patients With OUD

Slow-release oral morphine may be an effective treatment for people with opioid use disorder (OUD) who experience adverse events or unsatisfactory results with other forms of medication treatment, suggests a study in the Journal of Substance Abuse Treatment. The study also found that patients who took slow-release oral morphine drank less alcohol and reported an improvement in their mental and physical health.

“We know that all available medications, despite their effectiveness, can cause unwanted symptoms like adverse effects, and it often occurs that patients are using additional psychotropic substances. To counteract an unsatisfactory course of treatment, we need a therapy tailored to the patient’s conditions,” said lead author Kirsten Lehmann, M.P.H., a scientific assistant at the Centre for Interdisciplinary Addiction Research of Hamburg University at the University Medical Center Hamburg–Eppendorf in Germany.

Lehmann and her colleagues analyzed data from 180 adults with OUD from 23 outpatient treatment centers in Germany, where slow-release oral morphine is approved for OUD treatment. (It is not approved for treating OUD in the United States.) The patients had been taking medication treatment, such as racemic methadone, levomethadone, buprenorphine, or diamorphine for an average of seven years and had decided to switch to slow-release oral morphine because they were not satisfied with their current treatment. After 12 months, 60.6% were still being treated with slow-release oral morphine. The majority of those who stopped taking slow-release oral morphine switched back to their previous form of medication treatment.

An analysis of the patients’ mental health using the German version of the Brief Symptom Inventory-18 and the Global Severity Index revealed that symptoms of depression, anxiety, and somatization improved in patients with those conditions. Patients also reported improved physical health on the Opiate Treatment Index–Health Symptom Scale, a checklist of 50 symptoms that people with OUD often experience.

Roughly 24% of patients experienced adverse events over 12 months. However, only 31% of those adverse events were documented as having a possible, probable, or certain relationship to slow-release oral morphine.

A subset of 113 patients reported their prior 30-day substance use at several points throughout the study. From baseline to 12 months, the average number of days they used heroin in the previous 30 days dropped from 4.9 to 1.4, and the average number of days they used substances intravenously dropped from 2.7 to .02. The average number of days they used alcohol in the previous 30 days dropped from 6.4 to 4.0. Their scores on visual analog scales, which measure heroin cravings, decreased from 34.8 at baseline to 13.6 at 12 months.

Lehmann noted that the study did not add any interventions that could have affected the results. “Thus, the observed improvements in mental and physical health, alcohol consumption, and illegal drug use may be attributed primarily to [slow-release oral morphine],” she said.

This study was supported by an unrestricted grant from Mundipharma Deutschland GmbH & Co. KG. ■

 “Substitution Treatment for Opioid Dependence With Slow-Release Oral Morphine: Retention Rate, Health Status, and Substance Use After Switching to Morphine” is posted here.