Self-reported cravings for heroin and cocaine during maintenance treatment with slow-release oral morphine compared with methadone: a randomized, crossover clinical trial

J Clin Psychopharmacol. 2015 Apr;35(2):150-7. doi: 10.1097/JCP.0000000000000288.

Abstract

Objective: Craving, an urge or increased desire to take a drug, is part of a cluster of behavioral, cognitive, and physiological phenomena that can develop after substance use. Self-reported cravings for heroin and cocaine are compared in opioid dependent patients while receiving maintenance treatment with slow-release oral morphine (SROM) or methadone.

Methods: Data from a 22-week open-label, randomized, crossover trial (per protocol sample n = 157) were examined by analysis of variance (ANOVA). Cravings for heroin and cocaine during the past 7 days were assessed at baseline and thrice during each 11-week treatment period using a Visual Analog Scale (heroin, VAS-H; cocaine, VAS-C), German versions of the brief Heroin Craving Questionnaire (HCQ), and the brief Cocaine Craving Questionnaire (CCQ).

Results: Mean (SD) heroin craving scores under methadone were 3.3 (2.4) (VAS-H) and 2.9 (1.4) (HCQ). Heroin craving scores under SROM were significantly lower, at 2.5 (2.2) (VAS-H) and 2.6 (1.2) (HCQ) (ANOVA: VAS-H P < 0.0001, HCQ P = 0.010). Cocaine craving scores were not significantly different (methadone: 1.6 (2.0) (VAS-C) and 2.1 (1.2) (CCQ) vs SROM: 1.4 (1.9) (VAS-C) and 2.1 (1.2) (CCQ); ANOVA: VAS-C P = 0.175, CCQ P = 0.536). No significant carry-over effects were detected.

Conclusions: This study demonstrates that SROM is clinically more effective than methadone in reducing general craving for heroin during opioid maintenance treatment while not affecting cocaine craving.

Trial registration: ClinicalTrials.gov NCT01079117.

Publication types

  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cocaine-Related Disorders / psychology*
  • Cocaine-Related Disorders / rehabilitation*
  • Cross-Over Studies
  • Female
  • Heroin Dependence / psychology*
  • Heroin Dependence / rehabilitation*
  • Humans
  • Male
  • Methadone / administration & dosage
  • Methadone / therapeutic use*
  • Middle Aged
  • Morphine / administration & dosage
  • Morphine / therapeutic use*
  • Narcotics / administration & dosage
  • Narcotics / therapeutic use*
  • Opiate Substitution Treatment / psychology
  • Substance Withdrawal Syndrome / psychology*
  • Surveys and Questionnaires
  • Treatment Outcome
  • Young Adult

Substances

  • Narcotics
  • Morphine
  • Methadone

Associated data

  • ClinicalTrials.gov/NCT01079117
  • EudraCT/2008-002185-60