OPIOID AGONIST TREATMENT ALERT SLOW RELEASE ORAL MORPHINE SHORTAGE RESOLVED UPDATE:
February 27, 2018
From The British Columbia Centre on Substance Use
| The shortage of slow-release oral morphine, brand name KADIAN®, for the treatment of opioid use disorder has been resolved. |
Clinical management FOR ALL PATIENTS ON KADIAN® FOR OPIOID USE DISORDER PRIOR TO JANUARY 2018 SHORTAGE:
- Contact the patient to inform them of the shortage resolution and discuss their treatment plan to resume KADIAN® for the treatment of their opioid use disorder. It is important to discuss any changes in treatment and make a collaborative decision with your patients.
- Document this discussion and any treatment decisions in the patient’s medical record.
- Contact the pharmacy to discuss the clinical management strategy with the pharmacist.
OPTION 1 – CONVERT PATIENTS From M-ESLON® back to KADIAN®
- Convert and write a prescription for slow-release oral morphine brand name KADIAN® (same therapeutic dosage of M-ESLON®).
- This is a 1:1 ratio conversion (e.g., M-ESLON® 200 mg BID is equivalent to KADIAN® 400 mg/day).
- There is no need to decrease the dose by 25%, as it is the same opioid class.
- The prescription must clearly specify “for OAT” (opioid agonist treatment). An example prescription is provided below.
- KADIAN® must be prescribed as daily witnessed ingestion (DWI).
- Indicate to the patient that KADIAN® must be taken at the same time every day.
- KADIAN® is a 24-hour formulation, and requires only one dose per day, unlike the 12-hour M-ESLON® formulation which required two doses per day.
- KADIAN® is available in the following dosage strengths:
| NAME | PIN (for OAT) | DIN |
| Kadian® 10 mg capsule | 22123349 | 2242163 |
| Kadian® 20 mg capsule | 22123346 | 2184435 |
| Kadian® 50 mg capsule | 22123347 | 2184443 |
| Kadian® 100 mg capsule | 22123348 | 2184451 |
OPTION 2—Convert patients from buprenorphine/naloxone back to KADIAN®
- Ensure this option is collaboratively agreed upon with your patient.
- See the BCCSU Guideline for the Clinical Management of Opioid Use Disorder or call the RACE Line (1-877-696- 2131, press 1 for addiction medicine) for more information on transitioning from buprenorphine/naloxone to slow-release oral morphine.
OPTION 3—Convert patients from methadone back to KADIAN®
- Ensure this option is collaboratively agreed upon with your patient.
- Refer to the BCCSU Guideline for the Clinical Management of Opioid Use Disorder or call the RACE Line (1-877-696- 2131, press 1 for addiction medicine) for more information on transitioning from methadone to KADIAN®.
EXAMPLE PRESCRIPTION—KADIAN® FOR OAT
Additional References
BC PharmaCare Newsletter - Kadian® Shortage Over
Professional Practice Policy 66: Opioid Agnoist Treatment