M. Eugenia Socías, MD, MSc; Evan Wood, MD, PhD
Acknowledgment: The authors thank Jennifer Navin for her administrative assistance and Leo Beletsky for his legal advice.
Financial Support: Dr. Wood is a Tier 1 Canada Research Chairholder. Dr. Socías is supported by postdoctoral fellowship awards from the Michael Smith Foundation for Health Research and the Canadian Institute for Health Research.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2373.
Requests for Single Reprints: Evan Wood, MD, PhD, British Columbia Centre on Substance Use, 608-1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Socías and Wood: British Columbia Centre on Substance Use, 608-1081 Burrard Street, Vancouver, British Columbia V6Z 1Y6, Canada.
Author Contributions: Conception and design: M.E. Socías, E. Wood.
Analysis and interpretation of the data: M.E. Socías, E. Wood.
Drafting of the article: M.E. Socías.
Critical revision for important intellectual content: M.E. Socías, E. Wood.
Final approval of the article: M.E. Socías, E. Wood.
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Stephen B. Strum
Community Practice of Internal Medicine & Medical Oncology
December 26, 2017
Slow-Release Oral Morphine (SROM) vs Opioid Withdrawal
Exactly 50 years ago, as an intern on the jail ward of Los Angeles County-USC Medical Center, I vividly remember being instructed by our attending, Margaret McCarron MD, how to withdraw heroin or meperidine in severely addicted patients. This 3-day program worked amazingly well and used promazine (Sparine®) in attenuating doses administered over 72 hours. The regimen was based on the work of Rolo (1-2) dating back to 1957. During the first 24 hours, promazine was given at a dose of 75mg q 4 hours; then 75 mg q 6 hours on day 2 and on day 3 lowered to 75 mg q 8 hours. At the end of 3 days there was no narcotic craving and patients were discharged. In fact, opioid-addicted patients would voluntarily admit themselves to the hospital, albeit for the purpose of lowering the cost of the expensive habit they were on. It was clear that we could deal with the pharmacological side of addiction, or so it seemed. In other words, the issue was not the physical dependence as we understood it, but how to create an aversion to the patient's future desire to use narcotics. Does successfully treating narcotic addiction mandate some form(s) of psychological counseling (e.g., a 12-step program, medical hypnosis) or is there a deeper pharmacologic mechanism or switch that must be turned off?1. Rolo A: Promazine for management of the drug abstinence syndrome; rapid withdrawal of meperidine in a severely addicted patient. N Y State J Med 57:2701-2, 1957. 2. Rolo A: Drug withdrawal with promazine hydrochloride. N Y State J Med 62:1429-31, 1962.
Socías ME, Wood E. Evaluating Slow-Release Oral Morphine to Narrow the Treatment Gap for Opioid Use Disorders. Ann Intern Med. ;168:141–142. doi: 10.7326/M17-2373
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Published: Ann Intern Med. 2018;168(2):141-142.
Published at www.annals.org on 26 December 2017
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