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Development of pharmaceutical heroin preparations for medical co-prescription to opioid dependent patients

, : Development of pharmaceutical heroin preparations for medical co-prescription to opioid dependent patients. Drug and Alcohol Dependence 80(3): 283-295

Presently, there is a considerable interest in heroin-assisted treatment: co-prescription of heroin to certain Subgroups of chronic, treatment-resistant, opioid dependent patients. In 2002, nine countries had planned (Australia, Belgium,Canada, France, Spain) or ongoing (Germany,The Netherlands, Switzerland, United Kingdom) clinical trials on this subject. These trials (and the routine heroin-assisted treatment programs that might result) Will need pharmaceutical heroin (diacetylmorphine) to prescribe to the patients. Research into the development of pharmaceutical forms of heroin for prescription to addicts can benefit front the large amount Of knowledge that already exists regarding this Substance. Therefore, in this paper we review the physicochemical and pharmaceutical properties of diacetylmorphine and the clinically investigated routes of administration, as well as routes of administration Utilised oil the street in the context of developing pharmaceutical heroin formulations for prescription to addicts. Patient acceptability of the formulation is essential, because heroin-assisted treatment is aimed at treatment-resistant addicts, who often have to be encouraged to participate (or to maintain participation) in a treatment program. This means that the most Suitable products would have pharmacokinetic profiles mimicking that of diacetyl morphine for injection, with rapid peak concentrations of diacetylmorphine and 6-acetylmorphine, ensuring the 'rush effect' and the sustained presence of morphine(-6-glucuronide) creating the prolonged euphoria. Diacetylmorphine for inhalation after volatilisation (via 'chasing the dragon') seems to be a suitable candidate, while intranasal and oral diacetylmorphine are Currently thought to be unsuitable. However, oral and intranasal delivery systems might be improved and become suitable for use by heroin dependent patients. (c) 2005 Elsevier Ireland Ltd. All rights reserved.


PMID: 15916865

DOI: 10.1016/j.drugalcdep.2005.04.008

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