After the randomised injectable opiate treatment trial: Post-trial investigation of slow-release oral morphine as an alternative opiate maintenance medication

Introduction and Aims. To establish if slow-release oral morphine (SROM) is an acceptable maintenance medication in heroin users currently being prescribed injectable diamorphine, who are intolerant to supplementary methadone. 

Design and Methods. Case note review of interviews and medication details before and after change in medication in 12 treatment-resistant chronic heroin users attending a supervised injecting clinic twice a day for prescribed injectable diamorphine plus supplementary oral methadone to ensure 24 h stability. SROM was substituted for oral methadone by cross-titration. The patients' experiences of methadone treatment and expectations of SROM were recorded before the switch. Their responses to SROM and changes in injectable diamorphine requirements were recorded after a mean of 10 weeks' SROM treatment. 

Results. The patients described a dislike and intolerance of methadone but had positive expectations of SROM which they believed would allow them to reduce their diamorphine dose. The mean stable methadone : SROM maintenance dose ratio was 1:7.5. After 10 weeks' SROM treatment, the average daily diamorphine dose reduced from 382 mg to 315 mg and patients reported fewer cravings and improved sleep and well-being. 

Discussion and Conclusions. Alternative forms of maintenance medication are required for patients who are intolerant to methadone. SROM is a valuable alternative which enabled some patients to reduce both their dose and number of injections of diamorphine. SROM treatment may therefore represent a route to stop injecting.[Bond AJ, Reed KD, Beavan P, Strang J. After the randomised injectable opiate treatment trial: Post-trial investigation of slow-release oral morphine as an alternative opiate maintenance medication.