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Intravenous misuse of slow-release oral morphine capsules: how much morphine is injected?
Célian Bertin1,2,3, Edouard Montigne4, Sarah Teixeira4
1Université Clermont Auvergne, CHU Clermont-Ferrand, Inserm 1107 Neuro-Dol, Service de Pharmacologie Médicale, Centres Addictovigilance et Pharmacovigilance, Centre Evaluation et Traitement de la Douleur, Université Clermont Auvergne, 63003, Clermont-Ferrand, France. cbertin@chu-clermontferrand.fr.
Background:
The injection of morphine from morphine sulfate capsules containing sustained-release microbeads (Skenan®) is a practice frequently described by French intravenous opioid users. They seek an injectable form of substitution for heroin. Depending on how the syringe is prepared, the morphine rates may vary. The dosage of the capsule, the temperature of the dissolving water and the type of filter used have been identified as the parameters most likely to influence the final quantity of morphine in solution before intravenous injection. The aim of our study was to determine the amounts of morphine actually injected, according to the different preparation modalities described by people who inject morphine and the harm reduction equipment made available to them.
Methods:
Different morphine syringes were prepared by varying the dosage of the capsule (100 or 200 mg), the temperature of the dissolving water before adding morphine, ambient (≈ 22 °C) or heat (≈ 80 °C) and four filtration devices: risk reduction Steribox® cotton, risk reduction filter "Sterifilt®", "Wheel" filter and cigarette filter. The quantification of the morphine in the syringe body was carried out by liquid phase chromatography coupled with a mass spectrometry detector.
Results:
The best extraction yields were obtained with heated water, independently of dosages (p < 0.01). Yields of 100 mg capsules varied according to the filter (p < 0.01) and the water temperature (p < 0.01), with maximum yields obtained for solutions dissolved in heated water, then filtered with the "Wheel" filter (83 mg). The yields of the 200 mg capsules varied according to the temperature of the water (p < 0.01), without difference according to the filter used (p > 0.01), and maximum yields obtained for solutions dissolved in heated water (95 mg).
Conclusions:
No procedure for dissolving Skenan® led to the complete dissolution of the morphine it contains. Whatever the variations in preparation conditions, the extraction rates of the 200 mg morphine capsules were lower than those of 100 mg, without the risk reduction filters adversely impacting morphine extraction. Offering an injectable substitution to persons who inject morphine would make it possible to reduce the risks and damage, particularly overdoses, associated with variations in dosage due to preparation methods.
Insights
Injecting sustained-release morphine sulfate capsules (Skenan®) by intravenous opioid users results in variable morphine amounts. Heated water and specific filters optimize extraction, but complete dissolution is never achieved, highlighting risks of inconsistent dosing.
Area of Science:
- Pharmacology
- Drug Abuse Research
- Harm Reduction
Background:
- Intravenous opioid users often inject sustained-release morphine sulfate capsules (Skenan®) as a heroin substitute.
- Preparation methods significantly influence the final morphine concentration available for injection.
- Key variables include capsule dosage, water temperature, and filtration techniques.
Purpose of the Study:
- To quantify the actual amount of morphine injected by users based on different preparation methods.
- To assess the impact of preparation variables and harm reduction equipment on morphine extraction yields.
- To inform harm reduction strategies for individuals injecting morphine.
Main Methods:
- Morphine sulfate capsules (100 or 200 mg) were prepared using varying water temperatures (ambient vs. heated) and filtration devices (Steribox®, Sterifilt®, Wheel filter, cigarette filter).
- Morphine concentration in the syringe was quantified using liquid chromatography coupled with mass spectrometry.
Main Results:
- Heated water significantly improved morphine extraction yields for both 100 mg and 200 mg capsules.
- The "Wheel" filter yielded the highest extraction for 100 mg capsules (83 mg) when used with heated water.
- Extraction yields for 200 mg capsules were highest with heated water (95 mg) and were not significantly affected by the filter type.
Conclusions:
- No preparation method achieved complete morphine dissolution from Skenan® capsules.
- Extraction rates were consistently lower for 200 mg capsules compared to 100 mg capsules.
- Harm reduction filters did not negatively impact morphine extraction; offering injectable opioid substitution could mitigate overdose risks associated with variable preparation methods.
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