Slow-release oral morphine for opioid maintenance treatment: a systematic review

Authors

  • Jeremie Jegu,

    Corresponding author
    1. Department of Medical and Clinical Pharmacology, Centre d’Evaluation et d’Information sur la Pharmacodépendance Addictovigilance (CEIP-A), University Hospital of Toulouse, 31000 Toulouse, France
    2. Department of Epidemiology, University Hospital of Toulouse, Faculté de Médecine, 31000 Toulouse, France
    Search for more papers by this author
  • Adeline Gallini,

    1. Department of Medical and Clinical Pharmacology, Centre d’Evaluation et d’Information sur la Pharmacodépendance Addictovigilance (CEIP-A), University Hospital of Toulouse, 31000 Toulouse, France
    Search for more papers by this author
  • Pauline Soler,

    1. Department of Epidemiology, University Hospital of Toulouse, Faculté de Médecine, 31000 Toulouse, France
    Search for more papers by this author
  • Jean-Louis Montastruc,

    1. Department of Medical and Clinical Pharmacology, Centre d’Evaluation et d’Information sur la Pharmacodépendance Addictovigilance (CEIP-A), University Hospital of Toulouse, 31000 Toulouse, France
    2. INSERM 1027, Pharmacoepidemiology Research Team, University of Toulouse, Faculté de Médecine, 31000 Toulouse, France
    Search for more papers by this author
  • Maryse Lapeyre-Mestre

    1. Department of Medical and Clinical Pharmacology, Centre d’Evaluation et d’Information sur la Pharmacodépendance Addictovigilance (CEIP-A), University Hospital of Toulouse, 31000 Toulouse, France
    2. INSERM 1027, Pharmacoepidemiology Research Team, University of Toulouse, Faculté de Médecine, 31000 Toulouse, France
    Search for more papers by this author

Dr Jeremie Jegu, Laboratoire d'Epidémiologie et de Santé Publique, Faculté de Médecine, Université de Strasbourg, 4 rue Kirschleger, 67000 Strasbourg, France.
Tel.: +33 3 68 85 32 02
Fax: +33 3 68 85 31 89
E-mail: jeremie.jegu@unistra.fr

Abstract

This review article summarizes the results of all available clinical trials considering the use of slow-release oral morphine (SROM) for opioid maintenance treatment (OMT). All studies published up to October 2010 and assessing SROM for OMT in adult patients are included. Three independent reviewers assessed the selected articles using a standardized checklist. Study design, study length and number of subjects included were recorded. Data about retention rate (proportion of participants remaining under maintenance treatment at the end of the study), quality of life, withdrawal symptoms, craving, additional drug consumption, driving capacity and adverse events were collected. We identified 13 articles corresponding to nine clinical trials considering the use of SROM for OMT. Among them, only one was a randomized trial and one was a controlled not randomized trial. All other studies were uncontrolled. Retention rates were good (from 80.6 to 95%) with SROM maintenance, but similar retention rates were obtained with methadone. Most of the studies showed that quality of life, withdrawal symptoms, craving and additional drug consumption improved with SROM. However, there was no comparison with other maintenance drugs. As most of the studies assessing SROM efficacy were uncontrolled, there is no definite evidence that SROM is an effective alternative to methadone for OMT.

Ancillary