ArticleBritish journal of clinical pharmacology2020
Risk assessment of using off-label morphine sulfate in a population-based retrospective cohort of opioid-dependent patients.
Article in British journal of clinical pharmacology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
10 citing papers in PubMed, 2 syntheses or guidelines pooled it, 20 citations in OpenAlex.
- Guideline
- Management of opioid use disorder: 2024 update to the national clinical practice guideline.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2024Guideline
- Effectiveness of slow-release oral morphine versus other OAT regimens in key sub-populations: protocol for population-based target trial emulation.medRxiv : the preprint server for health sciences · 2025Article
- Prevalence of stimulant use and the role of opioid agonist treatment among people who inject drugs in France: Results from the COSINUS cohort study.Drug and alcohol review · 2025Article
- Challenges for the implementation of injectable opioid agonist treatment: a scoping review.Harm reduction journal · 2024Article
- People who inject oral morphine favor experimentation with injectable opioid substitution.Harm reduction journal · 2023Article
- Intravenous misuse of slow-release oral morphine capsules: how much morphine is injected?Harm reduction journal · 2023Article
- Oral Morphine as an Alternative Substitution Treatment for Opioid Use Disorder, a Rare but Non-risk-free Use.Frontiers in psychiatry · 2022Article
- Risk assessment of using off-label morphine sulfate in a population-based retrospective cohort of opioid-dependent patients.British journal of clinical pharmacology · 2020Article
- Problems with hydromorphone prescribing as a response to the opioid crisis.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2020Article
Corrections and comments
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Authors and funding
9 authors at 3 institutions in 1 country.
Funding
Abstract
aimsSeveral addictovigilance studies have described the off-label use of morphine sulfate (MS) for nonchronic pain in opioid use disorder (OUD) patients as an alternative to conventional opioid substitution treatments (OSTs). This study primarily sought to compare the incidence of unintentional opioid-related overdose in the year following the prescription initiation in off-label MS users, compared to OST-maintained patients.
methodsSequential cohorts of OUD patients who were regularly dispensed MS, buprenorphine, or methadone, between 1 April 2012 and 31 December 2014, were retrospectively identified using the French nationwide healthcare data system. The incidence of overdoses, deaths, doctor shopping, and complications of a viral, bacterial or thrombotic nature, was compared using the Cox regression method.
resultsOverall, 1075, 20 834 and 9778 OUD patients without chronic-pain were included in the MS, buprenorphine, and methadone cohorts, respectively. Overdose incidence was 3.8 (P < .01 [95% confidence interval (CI): 2.1-6.8]) and 2.0 (P = .02 [95%CI: 1.1-3.6]) higher in the MS cohort vs buprenorphine and methadone, respectively. Death incidence was 9.1 (P < .01 [95%CI: 3.2-25.9]) and 3.9 (P < .01 [95%CI: 1.4-10.7]) higher in the MS cohort vs buprenorphine and methadone, respectively. The incidences of other associated risks were significantly higher in the MS group vs OSTs, except for hepatitis C viral infection and thrombotic complications.
conclusionThis first French comprehensive nationwide study reveals increasing overdose, death, bacterial infection, abuse and diversion risks when off-label MS is initiated as alternative to OST. These results question the relevance of prescribing MS as a safe opioid maintenance treatment, considering its health risk profile.
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Registered trials
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