Theme: Models of Care Year: 2022
In Canada, opioid agonist therapy (OAT) is the first-line treatment for opioid use disorder and has
been proven an effective strategy to lower incidence of hepatitis C and other drug-related harms in
people who inject drugs. Although buprenorphine/naloxone and methadone are the standard
treatment, there has been an increased interest in the use of slow-release oral morphine (SROM)
and a growing literature on the matter. Despite indicated off-label as an OAT in Canada, SROM offers
an alternative option for those still without treatment. SROM is administered orally, once daily, and
can be prescribed in addition to safer supply. This Guide to using SROM is aiming to summarize
available literature and clinical expertise to support clinicians in their practice.
Description of model of care/intervention:
The Guide presents SROM characteristics from general principles to eligibility, contraindications and
precautions, and highlights our provincial recommendations in which SROM is placed as a first-line
treatment along with standard options. The Guide and recommendations were developed using the
Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach with an
Expert Review Committee composed of peer-based organizations and clinical practitioners.
SROM is proven to have advantages compared to methadone, such as less impact on QTc, less drug
interactions, less symptoms of depression and anxiety, while having similar retention rates, nonopioid substance use, and adverse events. It’s also shown to improve well-being and treatment
satisfaction and could reduce heroin cravings and heroin use more effectively.
Conclusion and next steps:
The Guide to using SROM is one more step towards meeting people’s needs, offering more flexibility
that could result in less drug-related harms, and providing guidance to clinicians. However, the use
of SROM still needs to be generalized and studied, in a context where very few OAT options coexist
and are not widely available across the country.
Disclosure of Interest Statement:
The work conducted by L’Équipe de soutien clinique et organisationnel en dépendance et itinérance
(ESCODI) is funded by the Institut universitaire sur les dépendances (IUD) through the Direction des
services en dépendance et itinérance du ministère de la Santé et des Services sociaux du Québec and
by Health Canada’s Substance Use and Addictions Program (SUAP).