PMID- 28521199
OWN - NLM
STAT- MEDLINE
DCOM- 20180124
LR  - 20181202
IS  - 1879-0046 (Electronic)
IS  - 0376-8716 (Linking)
VI  - 176
DP  - 2017 Jul 1
TI  - Safety profile of injectable hydromorphone and diacetylmorphine for long-term 
      severe opioid use disorder.
PG  - 55-62
LID - S0376-8716(17)30188-6 [pii]
LID - 10.1016/j.drugalcdep.2017.02.021 [doi]
AB  - AIMS: To review the safety profile of injectable hydromorphone and 
      diacetylmorphine and explore if adverse events (AEs) or serious adverse events 
      (SAEs) were associated with dose and patterns of attendance. METHODS: This was a 
      non-inferiority randomized double-blind controlled trial (Vancouver, Canada) 
      testing hydromorphone (n=100) and diacetylmorphine (n=102) for the treatment of 
      severe opioid use disorder. Medications were delivered under the supervision of 
      trained Registered Nurses up to three times daily. AEs were described using 
      MedDRA codes. RESULTS: Most common related AEs included immediate post-injection 
      reaction or injection site pruritus reactions, somnolence and opioid overdoses. 
      Adjusted analysis indicated that participants in the hydromorphone group were 
      less likely to have any related AE or SAE compared to the diacetylmorphine group. 
      Related somnolence and opioid overdose events were distributed throughout the six 
      months treatment period. In the diacetylmorphine group, five of the eleven 
      related SAE opioid overdoses (requiring naloxone) occurred in the first 30days 
      since most recent treatment initiation. Analysis of somnolence and opioid 
      overdose (AEs and SAEs) event rates by received dose suggested a non-linear 
      relationship. However, in the diacetylmorphine group higher event rates per 
      person days were recorded at lower doses. CONCLUSIONS: When injectable 
      hydromorphone and diacetylmorphine are individually dosed and monitored, their 
      opioid-related side effects, including potential fatal overdoses, are safely 
      mitigated and treated by health care providers. In the midst of an opioid 
      overdose epidemic, injectable options are timely to reach a very important 
      minority of people who inject street opioids and are not attracted to other 
      treatments.
CI  - Copyright (c) 2017. Published by Elsevier B.V.
FAU - Oviedo-Joekes, Eugenia
AU  - Oviedo-Joekes E
AD  - Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. 
      Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada; School of 
      Population and Public Health, University of British Columbia, 2206 East Mall, 
      Vancouver, BC, V6T 1Z3, Canada. Electronic address: eugenia@cheos.ubc.ca.
FAU - Brissette, Suzanne
AU  - Brissette S
AD  - Centre de recheche du Centre Hospitalier de l'Universite de Montreal, (CRCHUM), 
      900 St-Denis, Montreal, QC, H2X 0A9, Canada.
FAU - MacDonald, Scott
AU  - MacDonald S
AD  - Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, 
      Vancouver, BC V6 B 1G6, Canada.
FAU - Guh, Daphne
AU  - Guh D
AD  - Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. 
      Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.
FAU - Marchand, Kirsten
AU  - Marchand K
AD  - Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. 
      Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada; School of 
      Population and Public Health, University of British Columbia, 2206 East Mall, 
      Vancouver, BC, V6T 1Z3, Canada.
FAU - Jutha, Salima
AU  - Jutha S
AD  - Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. 
      Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.
FAU - Harrison, Scott
AU  - Harrison S
AD  - Providence Health Care, Providence Crosstown Clinic, 84 West Hastings Street, 
      Vancouver, BC V6 B 1G6, Canada.
FAU - Janmohamed, Amin
AU  - Janmohamed A
AD  - Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. 
      Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.
FAU - Zhang, Derek Z
AU  - Zhang DZ
AD  - Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. 
      Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada.
FAU - Anis, Aslam H
AU  - Anis AH
AD  - Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. 
      Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada; School of 
      Population and Public Health, University of British Columbia, 2206 East Mall, 
      Vancouver, BC, V6T 1Z3, Canada.
FAU - Krausz, Michael
AU  - Krausz M
AD  - Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. 
      Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada; 
      Department of Psychiatry, Faculty of Medicine, Detwiller Pavilion 2255 Wesbrook 
      Mall, Vancouver, BC V6T 2A1, Canada.
FAU - Marsh, David C
AU  - Marsh DC
AD  - Northern Ontario School of Medicine, 935 Ramsey Lake Road, Sudbury, ON P3E 2C6, 
      Canada.
FAU - Schechter, Martin T
AU  - Schechter MT
AD  - Centre for Health Evaluation and Outcome Sciences, Providence Health Care, St. 
      Paul's Hospital, 575- 1081 Burrard St., Vancouver, BC, V6Z 1Y6, Canada; School of 
      Population and Public Health, University of British Columbia, 2206 East Mall, 
      Vancouver, BC, V6T 1Z3, Canada.
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
DEP - 20170510
PL  - Ireland
TA  - Drug Alcohol Depend
JT  - Drug and alcohol dependence
JID - 7513587
RN  - 0 (Analgesics, Opioid)
RN  - 36B82AMQ7N (Naloxone)
RN  - 70D95007SX (Heroin)
RN  - Q812464R06 (Hydromorphone)
SB  - IM
MH  - Adult
MH  - Analgesics, Opioid/*administration & dosage
MH  - Canada/epidemiology
MH  - Double-Blind Method
MH  - Drug Overdose/diagnosis/drug therapy/epidemiology
MH  - Female
MH  - Heroin/administration & dosage
MH  - Heroin Dependence/diagnosis/drug therapy/epidemiology
MH  - Humans
MH  - Hydromorphone/*administration & dosage
MH  - Injections
MH  - Male
MH  - Middle Aged
MH  - Naloxone/therapeutic use
MH  - Opioid-Related Disorders/*diagnosis/*drug therapy/epidemiology
MH  - Self Administration
MH  - *Severity of Illness Index
MH  - Time Factors
OTO - NOTNLM
OT  - Adverse events
OT  - Injectable diacetylmorphine
OT  - Injectable hydromorphone
OT  - Opioid use disorder
EDAT- 2017/05/19 06:00
MHDA- 2018/01/25 06:00
CRDT- 2017/05/19 06:00
PHST- 2016/09/23 00:00 [received]
PHST- 2017/02/21 00:00 [revised]
PHST- 2017/02/21 00:00 [accepted]
PHST- 2017/05/19 06:00 [pubmed]
PHST- 2018/01/25 06:00 [medline]
PHST- 2017/05/19 06:00 [entrez]
AID - S0376-8716(17)30188-6 [pii]
AID - 10.1016/j.drugalcdep.2017.02.021 [doi]
PST - ppublish
SO  - Drug Alcohol Depend. 2017 Jul 1;176:55-62. doi: 10.1016/j.drugalcdep.2017.02.021. 
      Epub 2017 May 10.