Potency ratio of hydromorphone and diacetylmorphine in substitution treatment for long-term opioid dependency

Authors

  • Eugenia Oviedo-Joekes, PhD
  • David C. Marsh, MD
  • Daphne Guh, MSc
  • Suzanne Brissette, MD
  • Martin T. Schechter, MD, PhD

DOI:

https://doi.org/10.5055/jom.2011.0078

Keywords:

opioid dependency, hydromorphone, diacetylmorphine, substitution treatment with opioid agonists, equipotency

Abstract

Background: Data on conversion ratios for switching opioids in substitution treatment are limited.
Methods: Data were obtained from a randomized controlled trial among long-term opioid-dependent patients conducted in Vancouver and Montreal, Canada. Patients received diacetylmorphine (n 115) or hydromorphone (n 25) on a double-blind basis, on a 1:3 potency ratio with individually adjusted dosage, both injectable.
Results: Average daily dosages of hydromorphone and diacetylmorphine prescribed were 212.6 mg and 454.0 mg, respectively; potency ratio was 1:2.0-2.2 at different dose ranges.
Conclusions: Studies using hydromorphone as a diacetylmorphine equivalent should consider the ratio found in this study to achieve equipotency and maintain the blinding.

Author Biographies

Eugenia Oviedo-Joekes, PhD

School of Population and Public Health, University of British Columbia; Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, British Columbia, Canada.

David C. Marsh, MD

Northern Ontario School of Medicine, Sudbury, Ontario, Canada.

Daphne Guh, MSc

Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, British Columbia, Canada.

Suzanne Brissette, MD

Service de Médecine des Toxicomanies, Hôpital Saint-Luc, CHUM, Montréal, Quebec, Canada.

Martin T. Schechter, MD, PhD

School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.

References

Cherny NI: Opioid analgesics: Comparative features and prescribing guidelines. Drugs. 1996; 51: 713-737.

Haasen C, van den Brink W: Innovations in agonist maintenance treatment of opioid-dependent patients. Curr Opin Psychiatry. 2006; 19: 631-636.

Anderson R, Saiers JH, Abram S, et al.: Accuracy in equianalgesic dosing. Conversion dilemmas. J Pain Symptom Manage. 2001; 21: 397-406.

Pereira J, Lawlor P, Vigano A, et al.: Equianalgesic dose ratios for opioids. A critical review and proposals for long-term dosing. J Pain Symptom Manage. 2001; 22: 672-687.

Hill JL, Zacny JP: Comparing the subjective, psychomotor, and physiological effects of intravenous hydromorphone and morphine in healthy volunteers. Psychopharmacology (Berl). 2000; 152: 31-39.

Shaheen PE, Walsh D, Lasheen W, et al.: Opioid equianalgesic tables: Are they all equally dangerous? J Pain Symptom Manage. 2009; 38: 409-417.

Seidenberg A, Honegger U: Metadona, hero’na y otros opioides: Manual para un tratamiento ambulatorio de mantenimiento con opioides. Granada: Ediciones de D’az de Santos, 2000.

Patanwala AE, Duby J, Waters D, et al.: Opioid conversions in acute care. Ann Pharmacother. 2007; 41: 255-266.

Haemmig RB, Tschacher W: Effects of high-dose heroin versus morphine in intravenous drug users: A randomised doubleblind crossover study. J Psychoactive Drugs. 2001; 33: 105-110.

Oviedo-Joekes E, Brissette S, Marsh DC, et al.: Diacetylmorphine versus methadone for the treatment of opioid addiction. N Engl J Med. 2009; 361: 777-786.

Oviedo-Joekes E, Guh D, Brissette S, et al.: Double-blind injectable hydromorphone versus diacetylmorphine for the treatment of opioid dependence: A pilot study. J Subst Abuse Treat. 2010; 38: 408-411.

Greenwald MK, Hursh SR: Behavioral economic analysis of opioid consumption in heroin-dependent individuals: Effects of unit price and pre-session drug supply. Drug Alcohol Depend. 2006; 85: 35-48.

Strain EC, Walsh SL, Bigelow GE: Blockade of hydromorphone effects by buprenorphine/naloxone and buprenorphine. Psychopharmacology (Berl). 2002; 159: 161-166.

Preston KL, Bigelow GE: Effects of agonist-antagonist opioids in humans trained in a hydromorphone/not hydromorphone discrimination. J Pharmacol Exp Ther. 2000; 295: 114-124.

Wallenstein SL, Houde RW, Portenoy R, et al.: Clinical analgesic assay of repeated and single doses of heroin and hydromorphone. Pain. 1990; 41: 5-13.

Oviedo-Joekes E, Nosyk B, Marsh D, et al.: Scientific and political challenges in North America’s first randomized controlled trial of heroin-assisted treatment for severe heroin addiction: Rationale and design of the NAOMI study. Clin Trials. 2009; 6: 261-271.

Oviedo-Joekes E, Nosyk B, Brissette S, et al.: The North American Opiate Medication Initiative (NAOMI): Profile of participants in North America’s first trial of heroin-assisted treatment. J Urban Health. 2008; 85: 812-825.

Dunbar PJ, Chapman CR, Buckley FP, et al.: Clinical analgesic equivalence for morphine and hydromorphone with prolonged PCA. Pain. 1996; 68: 265-270.

Mahler DL, Forrest WH Jr: Relative analgesic potencies of morphine and hydromorphone in postoperative pain. Anesthesiology. 1975; 42: 602-607.

Jasinski DR, Preston KL: Comparison of intravenously administered methadone, morphine and heroin. Drug Alcohol Depend. 1986; 17: 301-310.

Martin WR, Fraser HF: A comparative study of physiological and subjective effects of heroin and morphine administered intravenously in postaddicts. J Pharmacol Exp Ther. 1961; 133: 388-399.

McNicol E: Opioid equianalgesic conversions. J Pain Palliat Care Pharmacother. 2009; 23: 458; author reply 459.

Brands B, Marsh D, Busto U, et al.: Comparison of heroin and hydromorphone in opioid users. Clin Pharmacol Ther. 2004; 75: P3.

Published

09/01/2011

How to Cite

Oviedo-Joekes, PhD, E., D. C. Marsh, MD, D. Guh, MSc, S. Brissette, MD, and M. T. Schechter, MD, PhD. “Potency Ratio of Hydromorphone and Diacetylmorphine in Substitution Treatment for Long-Term Opioid Dependency”. Journal of Opioid Management, vol. 7, no. 5, Sept. 2011, pp. 371-6, doi:10.5055/jom.2011.0078.