Medications for Opioid Use Disorder in People Who Inject Substances: Reflection on the Potential Place of Morphine Sulfate as Substitution Treatment? Results of COSINUS Cohort Study
Substance Use & Misuse. 2024-12-09; : 1-10
DOI: 10.1080/10826084.2024.2434005
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Lalanne L(1)(2), Davalos JR(3), Audran M(3), Hamelin N(4), Chauvin C(3),
Briand-Madrid L(5)(6), Kervran C(7), Kirchherr S(4)(8), Auriacombe M(9)(10)(11),
Roux P(5), Jauffret-Roustide M(3)(12)(13)(14); Cosinus Study Group.
Author information:
(1)INSERM Unit 1329, STEP (Strasbourg Translationnal Neuroscience and
Psychiatry)-CRBS (Centre de recherche en biomédecine de Strasbourg), Strasbourg.
(2)Department of Addictology, University Hospital of Strasbourg, Fédération de
Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France.
(3)Centre d’étude des mouvements sociaux (Inserm U1276, /UMR CNRS 8044,
/EHESS/Paris), Paris, France.
(4)INSERM 1114, Department of Psychiatry and Addictology, University Hospital of
Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS),
Strasbourg, France.
(5)Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de
la Santé & Traitement de l’Information Médicale, Marseille, France.
(6)ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d’Azur,
Marseille, France.
(7)Univ. Bordeaux, INSERM, BPH, U1219, I-prev/PHARES, Equipe Labellisée Ligue
Contre le Cancer, Bordeaux, France.
(8)Department of Physiology and Pharmacology, Sapienza University, Rome, Italy.
(9)Department of psychiatry, Perelman School of Medicine, University of
Pennsylvania, Philadelphia, PA, USA.
(10)Addiction Team (Laboratoire de psychiatrie)/SANPSY, CNRS USR 3413, Bordeaux,
France.
(11)Pôle inter-établissement Addictologie, CH Charles Perrens and CHU de
Bordeaux, Bordeaux, France.
(12)British Columbia Center on Substance Use (BCCSU), Vancouver, Canada.
(13)Baldy Center on Law and Social Policy, Buffalo University, New York, USA.
(14)Institut interuniversitaire sur les dependances, Montréal, Canada.
BACKGROUND: Opioid Use Disorder (OUD) often provokes dramatic consequences in
terms of increased morbi-mortality. Two medications have mainly been worldwide
used for OUD (MOUD), buprenorphine and methadone. Recently, however, some
reports have highlighted the use of Morphine Sulfate (MS) mainly obtained
without a prescription but used as MOUD by opioid users and especially People
Who Inject Substances (PWIS). We propose to characterize the prevalence and
distribution of MOUD and MS use in PWIS.
METHODS: This study examines the use of MOUD and MS amongst French PWIS
recruited in harm reduction facilities and drug consumption rooms in the context
of the COSINUS (Cohort to assess structural and individual factors in drug use)
study.
RESULTS: MOUD are prescribed, respectively, to one-third and one-fifth of PWIS,
whereas a half of them declared MS consumption without prescription. MS users
live with higher precariousness and are younger than non-users. MS is associated
with salt cocaine and heroin use. It is often consumed with methadone and more
rarely with buprenorphine and we hypothesized that this is probably linked to
buprenorphine’s pharmacological antagonism.
DISCUSSION: Our results show the high prevalence of MS consumption and highlight
the importance of considering the highly restricted possibility of prescribing
MS as MOUD. Its association with methadone raises the question of their
synergistic action on craving and mental disorders. The profiles of opioid users
who could benefit from MS with or without methadone must be examined to improve
their care but with the utmost caution, given the risk of overdose.
DOI: 10.1080/10826084.2024.2434005
PMID: 39654096