Morphine sulphate consumption by French drug users. Recent trends (2012-2013)

Morphine sulphate is the active ingredient in a class of opioid medications indicated in the treatment of intense pain and/or pain uncontrolled by other analgesics. Although they do not have marketing authorisations for use in treating opioid drug addiction, morphine sulphates are sometimes prescribed in this indication, either within the scope of the “Girard circular” of 27 June 1996 or outside of this framework. Moreover, morphine sulphate-based medications can be used for reasons other than substitution by drug users and be misappropriated for sale on the black market.

The main morphine medication that is misappropriated is Skenan® LP, a sustained release formulation that exists in several dosages of microsphere-filled capsules. Moscontin® LP, another sustained-release formulation, sold in tablet form by a different company, and Actiskenan®, a rapid-release formulation, are not very present on the black market and do not seem to be particularly sought-after. Medications containing morphine sulphate are classified as narcotics.

Two main reasons help to explain the rise in demand:

• Firstly, there has been a heroin “shortage” in Europe since 2011, which was evidenced in France by a significant decrease in heroin purity, and especially the heroin purity/price ratio. For opioid users making choices on the market based on factors such as substance quality, accessibility and price, this situation has led them to shift to morphine sulphate, which they deem to be similar to heroin. This is obviously due more to the “high” that goes along with morphine sulphate use than with the substance’s “treatment” facet. It explains the geography of use in part. However, starting in 2013, there has been an apparent rise in heroin purity recorded.
• The increase seems to be related to the search for a “different” type of substitution, especially among patients who are not satisfied with methadone or high dose buprenorphine (HDB). Morphine sulphate is considered as “injectable” (contrary to methadone) and the source of a “flash” 4 or at least a perceived effect (contrary to HDB), two aspects that many illegal drug users receiving treatment cannot seem to give up.

Finally, the hypothesis that methadone is difficult to access in certain rural areas should be explored given the geographic differences in use among CAARUDs (low-threshold structures) clients.