Lalanne Laurence, Davalos Julio Ricardo, Audran Martin, Hamelin Naomi, Chauvin Carole, Briand-Madrid Laelia, Kervran Charlotte, Kirchherr Sébastien, Auriacombe Marc, Roux Perrine, Jauffret-Roustide Marie
INSERM Unit 1329, STEP (Strasbourg Translationnal Neuroscience and Psychiatry)-CRBS (Centre de recherche en biomédecine de Strasbourg), Strasbourg.
Department of Addictology, University Hospital of Strasbourg, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Strasbourg, France.
Subst Use Misuse. 2025;60(3):393-402. doi: 10.1080/10826084.2024.2434005. Epub 2024 Dec 9.
Opioid Use Disorder (OUD) often provokes dramatic consequences in terms of increased morbi-mortality. Two medications have mainly been worldwide used for OUD (MOUD), buprenorphine and methadone. Recently, however, some reports have highlighted the use of Morphine Sulfate (MS) mainly obtained without a prescription but used as MOUD by opioid users and especially People Who Inject Substances (PWIS). We propose to characterize the prevalence and distribution of MOUD and MS use in PWIS.
This study examines the use of MOUD and MS amongst French PWIS recruited in harm reduction facilities and drug consumption rooms in the context of the COSINUS (Cohort to assess structural and individual factors in drug use) study.
MOUD are prescribed, respectively, to one-third and one-fifth of PWIS, whereas a half of them declared MS consumption without prescription. MS users live with higher precariousness and are younger than non-users. MS is associated with salt cocaine and heroin use. It is often consumed with methadone and more rarely with buprenorphine and we hypothesized that this is probably linked to buprenorphine's pharmacological antagonism.
Our results show the high prevalence of MS consumption and highlight the importance of considering the highly restricted possibility of prescribing MS as MOUD. Its association with methadone raises the question of their synergistic action on craving and mental disorders. The profiles of opioid users who could benefit from MS with or without methadone must be examined to improve their care but with the utmost caution, given the risk of overdose.
阿片类物质使用障碍（OUD）常常会在增加病亡率方面引发严重后果。在全球范围内，主要有两种药物被用于治疗OUD（药物辅助治疗，MOUD），即丁丙诺啡和美沙酮。然而，最近一些报告强调了硫酸吗啡（MS）的使用情况，这种药物主要是在没有处方的情况下获得的，但被阿片类物质使用者尤其是注射吸毒者（PWIS）用作MOUD。我们建议对PWIS中MOUD和MS的使用流行情况及分布特征进行描述。
本研究在“余弦”（评估药物使用中的结构和个体因素队列研究）研究背景下，调查了在减少伤害设施和药物消费室招募的法国PWIS中MOUD和MS的使用情况。
分别有三分之一和五分之一的PWIS被开具了MOUD处方，而其中一半的人宣称有无处方的MS消费。MS使用者的生活更不稳定，且比非使用者更年轻。MS与可卡因和海洛因的使用有关。它常与美沙酮一起使用，与丁丙诺啡一起使用的情况较少，我们推测这可能与丁丙诺啡的药理拮抗作用有关。
我们的结果显示了MS消费的高流行率，并强调了考虑将MS作为MOUD进行处方的可能性受到高度限制的重要性。它与美沙酮的关联引发了它们对渴望和精神障碍的协同作用问题。必须对可能受益于有或没有美沙酮的MS的阿片类物质使用者的特征进行研究，以改善对他们的治疗，但鉴于过量用药的风险，必须极其谨慎。
