Slow release oral morphine versus methadone for the treatment of opioid use disorder

Objective: To assess the efficacy of Slow release oral morphine (SROM) as a treatment for opioid use disorder. Design: Systematic review and meta-analysis of randomized controlled trials (RCT). Data sources: Three electronic databases were searched through May 1st, 2018: the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE. We also searched the following electronic registers for ongoing trials: ClinicalTrials.gov, World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP), Current Controlled Trials, and the EU Clinical Trials Register. Eligibility criteria for selecting studies: We included RCTs of any duration, assessing the effect of SROM on measures of treatment retention, heroin use and craving in adults who met the diagnostic criteria for opioid use disorder. Data extraction and synthesis: Two independent reviewers extracted data and assessed risk of bias. Data were pooled using the random-effects model and expressed as Risk Ratios (RR) or mean differences (MDs) with 95% CIs. Heterogeneity was assessed (chi-squared statistic) and quantified (I2 statistic) and a sensitivity analysis was undertaken to assess the impact of particular high-risk trials. Results: Among 1315 records screened and four studies reviewed, four unique randomized trials met inclusion criteria (n = 471), and compared SROM with methadone. In the meta-analysis, we observed no significant differences between SROM and methadone in improving treatment retention (risk ratio [RR] = 0.98; 95% Confidence Interval [CI]: 0.94 - 1.02, p = 0.34), and heroin use (RR = 0.96; 95% CI: 0.61- 1.52, p = 0.86). Craving data was not amenable to meta-analysis. Available data implied no differences in adverse events, heroin, cocaine, or benzodiazepine use. Conclusions: Meta-analysis of existing randomized trials suggests SROM may be generally equal to methadone in retaining patients in treatment and reducing heroin use as methadone while potentially resulting in less craving. The methodological quality of the included RCTs was low-to-moderate.European CommissionUS National Institutes of HealthCanada Research Chairs programCanadian Institutes of Health - Canadian Research Initiative on Substance MisuseMichael Smith Foundation for Health Research (MSFHR)Institutes of Health Research (CIHR) fellowship awardsSt. Paul’s Foundation Scholar Awar

Sublingual Buprenorphine and Methadone Maintenance Treatment: A Three-Year Follow-Up of Quality of Life Assessment

This study was conducted to compare long-term outcome effects on the quality of life (QOL) of oral methadone with sublingual buprenorphine maintenance treatment. The QOL status of opioid-dependent patients was assessed using the German version (“Berlin Quality of Life Profile”) of the Lancashire Quality of Life Profile. Physical symptoms were measured using the Opiate Withdrawal Scale (OWS). Urine tests were carried out randomly to detect additional consumption. In the first study period, 53 opioid-dependent subjects were enrolled and 25 could be reached after 3 years. The retention rate was 50% for methadone and 45% for buprenorphine (p = 0.786). Baseline values of the total sample (completers and noncompleters) QOL and somatic complaints did not show significant differences between the two treatment groups. QOL characteristics at 6 months of treatment of the buprenorphine completer and noncompleter groups differed significantly regarding job (p = 0.013), family, and total score of physical symptoms (p = 0.002), in which the completer group showed the more favorable values. Concerning physical symptoms at 36 months, logistic regression revealed significantly less stomach cramps (p = 0.037) and fatigue and tiredness (p = 0.034) in buprenorphine compared to the methadone. Moreover, the buprenorphine-maintained group showed significantly less additional consumption of benzodiazepines (p = 0.015) compared with methadone participants. It is concluded that opioid addicts improved their QOL and health status when treated with methadone or buprenorphine. In summary, regarding QOL and health status, the present data indicate that buprenorphine is also a useful long-term alternative for maintenance treatment of opioid-dependent patients