Oral Morphine as an Alternative Substitution Treatment for Opioid Use Disorder, a Rare but Non-risk-free Use.
healthcare database
morphine
morphine dependence
opioid
opioid maintenance treatment
overdose
prescription medication misuse
substance use disorder
Journal
Frontiers in psychiatry
ISSN: 1664-0640
Titre abrégé: Front Psychiatry
Pays: Switzerland
ID NLM: 101545006
Informations de publication
Date de publication:
2022
2022
Historique:
received:
10
03
2022
accepted:
07
06
2022
entrez:
18
7
2022
pubmed:
19
7
2022
medline:
19
7
2022
Statut:
epublish
Résumé
National health monitoring agencies have reported the alternative use of morphine sulfate painkiller for maintenance treatment of opioid use disorder (OUD), associated with a potential increase in overdose risk. This study sought to assess the prevalence of regular and occasional legally prescribed morphine use in patients treated for OUD and compare their characteristics to those of patients receiving conventional opioid maintenance treatment (OMT), buprenorphine or methadone. Then, we assessed the factors associated with opioid overdose risk. Data were extracted from the French national healthcare system database, covering the entire population in 2015. Diagnosis associated with hospital discharge and long-term disease codes were extracted to select the population and identify outcomes and covariates. OUD non-chronic pain patients were divided into regular (≤35 days between dispensing and ≥3 months of continuous treatment duration) morphine users, and occasional users. Their sociodemographic and health characteristics were compared to OMT controls. A multivariate logistic regression model was performed to determine factors associated with opioid overdose. In patients treated for OUD, 2,237 (2.2%) morphine users (1,288 regular and 949 occasional), 64,578 (63.7%) buprenorphine and 34,638 (34.1%) methadone controls were included. The prevalence of regular morphine use among patients treated for OUD regularly receiving an opioid was 1.3%. Compared to users who receive morphine regularly, occasional users had an increased risk of overdose [OR = 2.2 (1.5-3.3)], while the risk was reduced in the buprenorphine group [OR = 0.5 (0.4-0.7)] and not significantly different for methadone [OR = 1.0 (0.7-1.4)]. Other overdose risk factors were low-income, comorbidity, i.e., psychiatric conditions, alcohol use disorder or complications related to intravenous drug use, and coprescription with benzodiazepines or pregabalin. These factors were more frequent in morphine groups. Patients that were prescribed oral morphine represented a small minority of the treated for OUD. The poorer health condition affected by numerous comorbidities and higher risk of opioid overdose in patients treated with oral morphine compared with OMT controls points toward the need to better supervise the practices of these patients, to strengthen multidisciplinary care and risk reduction measures.
Sections du résumé
Background
UNASSIGNED
National health monitoring agencies have reported the alternative use of morphine sulfate painkiller for maintenance treatment of opioid use disorder (OUD), associated with a potential increase in overdose risk.
Objectives
UNASSIGNED
This study sought to assess the prevalence of regular and occasional legally prescribed morphine use in patients treated for OUD and compare their characteristics to those of patients receiving conventional opioid maintenance treatment (OMT), buprenorphine or methadone. Then, we assessed the factors associated with opioid overdose risk.
Methods
UNASSIGNED
Data were extracted from the French national healthcare system database, covering the entire population in 2015. Diagnosis associated with hospital discharge and long-term disease codes were extracted to select the population and identify outcomes and covariates. OUD non-chronic pain patients were divided into regular (≤35 days between dispensing and ≥3 months of continuous treatment duration) morphine users, and occasional users. Their sociodemographic and health characteristics were compared to OMT controls. A multivariate logistic regression model was performed to determine factors associated with opioid overdose.
Results
UNASSIGNED
In patients treated for OUD, 2,237 (2.2%) morphine users (1,288 regular and 949 occasional), 64,578 (63.7%) buprenorphine and 34,638 (34.1%) methadone controls were included. The prevalence of regular morphine use among patients treated for OUD regularly receiving an opioid was 1.3%. Compared to users who receive morphine regularly, occasional users had an increased risk of overdose [OR = 2.2 (1.5-3.3)], while the risk was reduced in the buprenorphine group [OR = 0.5 (0.4-0.7)] and not significantly different for methadone [OR = 1.0 (0.7-1.4)]. Other overdose risk factors were low-income, comorbidity, i.e., psychiatric conditions, alcohol use disorder or complications related to intravenous drug use, and coprescription with benzodiazepines or pregabalin. These factors were more frequent in morphine groups.
Conclusions
UNASSIGNED
Patients that were prescribed oral morphine represented a small minority of the treated for OUD. The poorer health condition affected by numerous comorbidities and higher risk of opioid overdose in patients treated with oral morphine compared with OMT controls points toward the need to better supervise the practices of these patients, to strengthen multidisciplinary care and risk reduction measures.
Identifiants
pubmed: 35845444
doi: 10.3389/fpsyt.2022.893590
pmc: PMC9282723
doi:
Types de publication
Journal Article
Langues
eng
Pagination
893590Informations de copyright
Copyright © 2022 Bertin, Bezin, Chenaf, Delorme, Kerckhove, Pariente, Tournier and Authier.
Déclaration de conflit d'intérêts
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Références
Eur Addict Res. 2013;19(5):235-44
pubmed: 23428846
Int J Drug Policy. 2008 Dec;19(6):450-8
pubmed: 18359216
JAMA Psychiatry. 2014 Dec 1;71(12):1400-8
pubmed: 25354080
Innov Clin Neurosci. 2012 Nov;9(11-12):42-6
pubmed: 23346518
Eur Addict Res. 2005;11(3):145-51
pubmed: 15990432
Presse Med. 2016 Apr;45(4 Pt 1):447-62
pubmed: 27067628
Wien Klin Wochenschr. 2002 Nov 30;114(21-22):904-10
pubmed: 12528322
Drug Alcohol Depend. 2016 May 1;162:99-106
pubmed: 27006272
World Psychiatry. 2017 Feb;16(1):102-104
pubmed: 28127929
Br J Gen Pract. 2011 Dec;61(593):e781-6
pubmed: 22137414
Infect Dis Clin North Am. 2002 Sep;16(3):589-605
pubmed: 12371117
Rev Epidemiol Sante Publique. 2017 Oct;65 Suppl 4:S149-S167
pubmed: 28756037
Br Med J (Clin Res Ed). 1983 Nov 19;287(6404):1549
pubmed: 6416496
Am J Psychiatry. 1996 Sep;153(9):1195-201
pubmed: 8780425
J Pain. 2015 May;16(5):445-53
pubmed: 25681095
J Clin Pharmacol. 2013 Jan;53(1):112-7
pubmed: 23400751
J Pain. 2016 Dec;17(12):1291-1301
pubmed: 27592608
JAMA Netw Open. 2020 Apr 1;3(4):e202361
pubmed: 32271389
PLoS Med. 2015 Oct 06;12(10):e1001885
pubmed: 26440803
J Infect. 1992 Sep;25(2):121-31
pubmed: 1431167
Ann Intern Med. 2018 Nov 20;169(10):732-734
pubmed: 30140853
Pharmacoepidemiol Drug Saf. 2017 Aug;26(8):954-962
pubmed: 28544284
Drug Alcohol Depend. 2017 Feb 01;171:39-49
pubmed: 28013096
Presse Med. 2016 Dec;45(12 Pt 1):e369-e375
pubmed: 27823911
Ment Health Clin. 2016 May 6;6(3):120-126
pubmed: 29955458
Lancet. 2017 Nov 4;390(10107):2016
pubmed: 29115231
J Chronic Dis. 1987;40(5):373-83
pubmed: 3558716
Addiction. 2014 Apr;109(4):617-26
pubmed: 24304412
PLoS Med. 2017 Oct 3;14(10):e1002396
pubmed: 28972983
Br J Psychiatry. 2007 Jul;191:55-62
pubmed: 17602126
PLoS One. 2015 May 12;10(5):e0125620
pubmed: 25965407
CNS Drugs. 2010 Jul;24(7):611-20
pubmed: 20527997
Eur J Pain. 2019 Jan;23(1):124-134
pubmed: 30051548
J Subst Abuse Treat. 2014 Oct;47(4):275-81
pubmed: 25064422
PLoS One. 2013 Jul 17;8(7):e69241
pubmed: 23874923
Eur J Cancer. 2011 Nov;47(16):2463-70
pubmed: 21775131
Med Care. 2005 Nov;43(11):1130-9
pubmed: 16224307
Br J Clin Pharmacol. 2020 Dec;86(12):2338-2348
pubmed: 31389036
BMJ. 2014 Sep 17;349:g5511
pubmed: 25231185
Fundam Clin Pharmacol. 2016 Oct;30(5):466-75
pubmed: 27315486
Drug Alcohol Depend. 2021 Oct 1;227:108984
pubmed: 34482044
Am J Public Health. 2015 Nov;105(11):e29-49
pubmed: 26451760
Am J Drug Alcohol Abuse. 2015 May;41(3):226-9
pubmed: 25860878
Pain Pract. 2010 Sep-Oct;10(5):428-50
pubmed: 20492579
Eur Addict Res. 2010;16(3):131-8
pubmed: 20424457
BMJ. 2018 Nov 14;363:k3532
pubmed: 30429167
Postepy Hig Med Dosw (Online). 2015 Apr 22;69:510-20
pubmed: 25983290
BMC Psychiatry. 2016 Aug 04;16:274
pubmed: 27488186
Br J Dermatol. 2004 Jan;150(1):1-10
pubmed: 14746612
Pain. 2018 Nov;159(11):2394-2402
pubmed: 30028790
Med Care. 2012 Jun;50(6):494-500
pubmed: 22410408
Postgrad Med. 2013 Jul;125(4):115-30
pubmed: 23933900
Addiction. 2008 Nov;103(11):1837-46
pubmed: 19032534
Drug Saf. 2012 Apr 1;35(4):325-34
pubmed: 22339505
Addiction. 2010 Jul;105(7):1192-202
pubmed: 20456295
Science. 1992 Feb 21;255(5047):946-52
pubmed: 1546291
CNS Neurosci Ther. 2016 Jan;22(1):25-37
pubmed: 26768685
Addiction. 2008 Jul;103(7):1120-30
pubmed: 18494841
Soc Psychiatry Psychiatr Epidemiol. 2022 Apr;57(4):647-671
pubmed: 34796369
Med Care. 1998 Jan;36(1):8-27
pubmed: 9431328
Addiction. 2005 Aug;100(8):1101-9
pubmed: 16042640
Addiction. 2006 Nov;101(11):1631-9
pubmed: 17034443
Am J Public Health. 2014 Aug;104(8):e32-42
pubmed: 24922138
Eur Addict Res. 2008;14(2):99-105
pubmed: 18334820
Addiction. 1999 Jul;94(7):961-72
pubmed: 10707430
J Pain. 2013 Feb;14(2):158-64
pubmed: 23253635
Subst Abuse. 2011;5:17-25
pubmed: 22879747