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1.  Maintenance treatment for opioid dependence with slow-release oral morphine: a randomized cross-over, non-inferiority study versus methadone 
Addiction (Abingdon, England)  2014;109(4):617-626.
To compare the efficacy of slow-release oral morphine (SROM) and methadone as maintenance medication for opioid dependence in patients previously treated with methadone.
Prospective, multiple-dose, open label, randomized, non-inferiority, cross-over study over two 11-week periods. Methadone treatment was switched to SROM with flexible dosing and vice versa according to period and sequence of treatment.
Fourteen out-patient addiction treatment centres in Switzerland and Germany.
Adults with opioid dependence in methadone maintenance programmes (dose ≥50 mg/day) for ≥26 weeks.
The efficacy end-point was the proportion of heroin-positive urine samples per patient and period of treatment. Each week, two urine samples were collected, randomly selected and analysed for 6-monoacetyl-morphine and 6-acetylcodeine. Non-inferiority was concluded if the two-sided 95% confidence interval (CI) in the difference of proportions of positive urine samples was below the predefined boundary of 10%.
One hundred and fifty-seven patients fulfilled criteria to form the per protocol population. The proportion of heroin-positive urine samples under SROM treatment (0.20) was non-inferior to the proportion under methadone treatment (0.15) (least-squares mean difference 0.05; 95% CI = 0.02, 0.08; P > 0.01). The 95% CI fell within the 10% non-inferiority margin, confirming the non-inferiority of SROM to methadone. A dose-dependent effect was shown for SROM (i.e. decreasing proportions of heroin-positive urine samples with increasing SROM doses). Retention in treatment showed no significant differences between treatments (period 1/period 2: SROM: 88.7%/82.1%, methadone: 91.1%/88.0%; period 1: P = 0.50, period 2: P = 0.19). Overall, safety outcomes were similar between the two groups.
Slow-release oral morphine appears to be at least as effective as methadone in treating people with opioid use disorder.
PMCID: PMC4226326  PMID: 24304412
Dose–response; maintenance treatment; methadone; opioid addiction; retention rate; slow-release oral morphine
2.  Comorbidity of paraphilia and depression in Mexico 
Mental Illness  2010;2(1):e8.
The comorbidity of paraphilia-related disorders and other psychiatric disorders is high, but the paraphilia-related disorder often remains untreated until patients seek help for the comorbid disorder. A case of a patient in Mexico with comorbid paraphilia and depressive disorder, who was effectively treated with antidepressive medication and psychotherapy, is reported. The effect of stigmatization of homosexuality on the access to care of persons with sexual disorders is discussed.
PMCID: PMC4253343  PMID: 25478091
paraphilia; depression; comorbidity; stigmatization.
3.  Heroin-assisted Treatment (HAT) a Decade Later: A Brief Update on Science and Politics 
Since the initial Swiss heroin-assisted treatment (HAT) study conducted in the mid-1990s, several other jurisdictions in Europe and North America have implemented HAT trials. All of these studies embrace the same goal—investigating the utility of medical heroin prescribing for problematic opioid users—yet are distinct in various key details. This paper briefly reviews (initiated or completed) studies and their main parameters, including primary research objectives, design, target populations, outcome measures, current status and—where available—key results. We conclude this overview with some final observations on a decade of intensive HAT research in the jurisdictions examined, including the suggestion that there is a mounting onus on the realm of politics to translate the—largely positive—data from completed HAT science into corresponding policy and programming in order to expand effective treatment options for the high-risk population of illicit opioid users.
PMCID: PMC2219559  PMID: 17562183
Heroin-assisted treatment; Science; Politics; Opioid dependence; Clinical trials

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