Evaluating Slow-Release Oral Morphine to Narrow the Treatment Gap for Opioid Use Disorders
Authors: M. Eugenia Socías, Evan Wood
Journal: Annals of Internal Medicine (2017)

Ideas and Opinions16 January 2018Evaluating Slow-Release Oral Morphine to Narrow the Treatment Gap for Opioid Use DisordersM. Eugenia Socías, MD, MSc and Evan Wood, MD, PhDM. Eugenia Socías, MD, MScUniversity of British Columbia and British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada (M.E.S., E.W.) and Evan Wood, MD, PhDUniversity of British Columbia and British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada (M.E.S., E.W.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-2373 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail North America is in the midst of an unprecedented public health crisis of opioid-related morbidity and mortality, fueled by the increasing contamination of the drug supply with illicitly manufactured fentanyl and related analogues (1). It is estimated that more than 2.5 million Americans have an opioid use disorder (OUD) and that more than 33 000 died from an opioid-related overdose in 2015—quadrupling the rates from 1999 (1). The scale and trajectory of the opioid overdose epidemic in North America underscore the need for an urgent scale-up and evaluation of science-driven solutions (2). Lessons drawn from the response to the HIV epidemic ...References1. O'Donnell JK, Gladden RM, Seth P. Trends in deaths involving heroin and synthetic opioids excluding methadone, and law enforcement drug product reports, by census region—United States, 2006-2015. MMWR Morb Mortal Wkly Rep. 2017;66:897-903. [PMID: 28859052] doi:10.15585/mmwr.mm6634a2 CrossrefMedlineGoogle Scholar2. Volkow ND, Collins FS. The role of science in addressing the opioid crisis. N Engl J Med. 2017;377:391-4. [PMID: 28564549] doi:10.1056/NEJMsr1706626 CrossrefMedlineGoogle Scholar3. Gates B. The next epidemic—lessons from Ebola. N Engl J Med. 2015;372:1381-4. [PMID: 25853741] doi:10.1056/NEJMp1502918 CrossrefMedlineGoogle Scholar4. Williams AR, Bisaga A. From AIDS to opioids—how to combat an epidemic. N Engl J Med. 2016;375:813-5. [PMID: 27579632] doi:10.1056/NEJMp1604223 CrossrefMedlineGoogle Scholar5. Connery HS. Medication-assisted treatment of opioid use disorder: review of the evidence and future directions. Harv Rev Psychiatry. 2015;23:63-75. [PMID: 25747920] doi:10.1097/HRP.0000000000000075 CrossrefMedlineGoogle Scholar6. Sharma A, Kelly SM, Mitchell SG, Gryczynski J, O'Grady KE, Schwartz RP. Update on barriers to pharmacotherapy for opioid use disorders. Curr Psychiatry Rep. 2017;19:35. [PMID: 28526967] doi:10.1007/s11920-017-0783-9 CrossrefMedlineGoogle Scholar7. Timko C, Schultz NR, Cucciare MA, Vittorio L, Garrison-Diehn C. Retention in medication-assisted treatment for opiate dependence: a systematic review. J Addict Dis. 2016;35:22-35. [PMID: 26467975] doi:10.1080/10550887.2016.1100960 CrossrefMedlineGoogle Scholar8. Canadian Agency for Drugs and Technologies in Health. Sustained Release Oral Morphine, Injectable Hydromorphone, and Prescription Diacetylmorphine for Opioid Use Disorder: Clinical and Cost-Effectiveness, and Guidelines. CADTH Rapid Response Report: Summary of Abstracts. Ottawa: Canadian Agency for Drugs and Technologies in Health; 2017. Accessed at https://cadth.ca/sustained-release-oral-morphine-injectable-hydromorphone-and-prescription-diacetylmorphine-opioid-0 on 15 August 2017. Google Scholar9. British Columbia Centre on Substance Use. A Guideline for the Clinical Management of Opioid Use Disorder. Vancouver, BC, Canada: British Columbia Centre on Substance Use; 2017. Accessed at www.bccsu.ca/wp-content/uploads/2017/06/BC-OUD-Guidelines_June2017.pdf on 12 August 2017. Google Scholar Author, Article, and Disclosure InformationAffiliations: University of British Columbia and British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada (M.E.S., E.W.)Acknowledgment: The authors thank Jennifer Navin for her administrative assistance and Leo Beletsky for his legal advice.Financial Support: Dr. Wood is a Tier 1 Canada Research Chairholder. Dr. Socías is supported by postdoctoral fellowship awards from the Michael Smith Foundation for Health Research and the Canadian Institute for Health Research.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2373.Corresponding Author: Evan Wood, MD, PhD, British Columbia Centre on Substance Use, 608-1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada; e-mail, [email protected]ubc.ca.Current Author Addresses: Drs. Socías and Wood: British Columbia Centre on Substance Use, 608-1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.Author Contributions: Conception and design: M.E. Socías, E. Wood.Analysis and interpretation of the data: M.E. Socías, E. Wood.Drafting of the article: M.E. Socías.Critical revision for important intellectual content: M.E. Socías, E. Wood.Final approval of the article: M.E. Socías, E. Wood.This article was published at Annals.org on 26 December 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byUptake of slow‐release oral morphine as opioid agonist treatment among hospitalised patients with opioid use disorderParticipants' Treatment Perspectives on a Clinical Trial on the Use of Extended-Release Naltrexone for Substance Use Disorders: Considerations for Future Clinical ResearchThe opioid overdose crisis as a global health challengeOpioid Addiction and Treatment'Safer opioid distribution' as an essential public health intervention for the opioid mortality crisis – Considerations, options and examples towards broad-based implementationSwitching opioid-dependent patients in substitution treatment from racemic methadone, levomethadone and buprenorphine to slow-release oral morphine: Analysis of the switching process in routine careEffects of periodic intake of drugs of abuse (morphine) on HIV dynamics: Mathematical model and analysisSlow release oral morphine versus methadone for opioid use disorder in the fentanyl era (pRESTO): Protocol for a non-inferiority randomized clinical trialFentanyl assisted treatment: a possible role in the opioid overdose epidemic?Successful treatment with slow-release oral morphine following afentanyl-related overdose: A case report 16 January 2018Volume 168, Issue 2Page: 141-142KeywordsDisclosureDrugsFood and Drug AdministrationMorphineOpioid use disorderOpioidsPatientsPrevention, policy, and public healthSafetyTreatment guidelines ePublished: 26 December 2017 Issue Published: 16 January 2018 Copyright & PermissionsCopyright © 2017 by American College of Physicians. 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