Double-blind injectable hydromorphone versus diacetylmorphine for the treatment
of opioid dependence: a pilot study.
Author(s): Oviedo-Joekes E, Guh D, Brissette S, Marsh DC, Nosyk B, Krausz M, Anis A,
Schechter MT.
Affiliation(s): School of Population and Public Health, University of British Columbia, BC,
Canada. eugenia@mail.cheos.ubc.ca
Publication date & source: 2010, J Subst Abuse Treat. , 38(4):408-11
Using data from the North American Opioid Maintenance Initiative study, a Phase
III randomized and parallel arm trial, this pilot study is aimed at testing if
treatment response with injectable hydromorphone differs compared to
diacetylmorphine in the treatment of long-term opioid addiction. A total of 140
long-term, treatment-refractory opioid-dependent individuals received either
injectable diacetylmorphine (n = 115) or hydromorphone (n = 25), in a
double-blind fashion, over 12 months. At the end of the study, none of the
participants in the hydromorphone group thought they were definitely receiving
this drug. Retention rates at 12 months with diacetylmorphine (87.8%; 95%
confidence interval [CI] = 80.5%-92.7%) and hydromorphone (88.0%; 95% CI =
68.7%-96.1%) were virtually identical. The use of illicit heroin in the prior
month declined from a mean of 26.6 and 26.3 days at baseline to 5.3 and 5.2 days
at 12 month in the diacetylmorphine and hydromorphone groups, respectively. There
were no differences between diacetylmorphine and hydromorphone in the adjusted
mean scores of the European Addiction Severity Index. There were no differences
in the safety profile of the medications. Hydromorphone may be similarly safe and
effective as diacetylmorphine as opioid-agonist substitution treatment; future
studies are required to confirm it. Further study will also be required to show
that open-label hydromorphone can also successfully attract patients into care
and retain them.
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