Potency ratio of hydromorphone and diacetylmorphine in substitution treatment for long-term opioid dependency

Eugenia Oviedo-Joekes, PhD; David C. Marsh, MD; Daphne Guh, MSc; Suzanne Brissette, MD; Martin T. Schechter, MD, PhD

doi:10.5055/jom.2011.0078

Authors

Eugenia Oviedo-Joekes, PhD
David C. Marsh, MD
Daphne Guh, MSc
Suzanne Brissette, MD
Martin T. Schechter, MD, PhD

DOI:

https://doi.org/10.5055/jom.2011.0078

Keywords:

opioid dependency, hydromorphone, diacetylmorphine, substitution treatment with opioid agonists, equipotency

Abstract

Background: Data on conversion ratios for switching opioids in substitution treatment are limited.
Methods: Data were obtained from a randomized controlled trial among long-term opioid-dependent patients conducted in Vancouver and Montreal, Canada. Patients received diacetylmorphine (n 115) or hydromorphone (n 25) on a double-blind basis, on a 1:3 potency ratio with individually adjusted dosage, both injectable.
Results: Average daily dosages of hydromorphone and diacetylmorphine prescribed were 212.6 mg and 454.0 mg, respectively; potency ratio was 1:2.0-2.2 at different dose ranges.
Conclusions: Studies using hydromorphone as a diacetylmorphine equivalent should consider the ratio found in this study to achieve equipotency and maintain the blinding.

Author Biographies

Eugenia Oviedo-Joekes, PhD

School of Population and Public Health, University of British Columbia; Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, British Columbia, Canada.

David C. Marsh, MD

Northern Ontario School of Medicine, Sudbury, Ontario, Canada.

Daphne Guh, MSc

Centre for Health Evaluation and Outcome Sciences, Providence Health Care, Vancouver, British Columbia, Canada.

Suzanne Brissette, MD

Service de Médecine des Toxicomanies, Hôpital Saint-Luc, CHUM, Montréal, Quebec, Canada.

Martin T. Schechter, MD, PhD

School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.

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