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Self-Reported Cravings for Heroin and Cocaine During Maintenance Treatment With Slow-Release Oral Morphine Compared With Methadone: A Randomized, Crossover Clinical Trial

Falcato, Luis MA*; Beck, Thilo MD*; Reimer, Jens MD; Verthein, Uwe PhD

Journal of Clinical Psychopharmacology: April 2015 - Volume 35 - Issue 2 - p 150–157
doi: 10.1097/JCP.0000000000000288
Original Contributions
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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.

From the *Arud Centers for Addiction Medicine, Zurich, Switzerland; and †Center for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany.

Received April 2, 2014; accepted after revision December 30, 2014.

Reprints: Luis Falcato, MA, Department of Research, Arud Centers for Addiction Medicine, Sihlhallenstrasse 30 PO CH-8026, Zurich, Switzerland (e-mail: l.falcato@arud.ch).

The clinical trial (Eudra CT no. 2008-002185-60, Swiss medic no. 2007DR3124, NIH study code NCT01079117) was designed and funded by Mundipharma Medical Company, Basel, Switzerland.

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