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Case Reports
. 2022 Jun 7;19(1):63.
doi: 10.1186/s12954-022-00644-2.

Nasal administration of diacetylmorphine improved the adherence in a patient receiving heroin-assisted treatment

Maximilian Meyer #  1 , Jean N Westenberg #  2   3 , Johannes Strasser  2 , Kenneth M Dürsteler  2   4 , Undine E Lang  2 , Michael Krausz  3 , Marc Vogel  2
Affiliations
Case Reports

Nasal administration of diacetylmorphine improved the adherence in a patient receiving heroin-assisted treatment

Maximilian Meyer et al. Harm Reduct J. .

Abstract

Background: Traditional heroin-assisted treatment in Switzerland consists of oral and injectable diacetylmorphine (pharmaceutical heroin) administration. To date, no suitable treatment option is available for patients who crave rapid onset ("rush") but are either unable to inject or primarily sniff or inhale illicit heroin. We present a patient who successfully switched to intranasal heroin-assisted treatment following several unsuccessful treatment attempts.

Case presentation: A 29-year-old male with severe opioid use disorder, injection substance use, and concomitant cocaine use, previously prescribed slow-release oral morphine, was started on intravenous diacetylmorphine. Due to complications and harms associated with intravenous injections, nasal diacetylmorphine was prescribed. With this novel route of administration, the patient who had previously been unable to adhere to other OAT options remained in treatment. Health outcomes improved by reduction of injection-related harms, increased adherence to the heroin-assisted treatment regimen, and increased collaboration with the therapeutic staff.

Conclusions: Nasal heroin-assisted treatment can be a feasible therapeutic option for individuals with severe opioid use disorder who crave the fast onset of effect of diacetylmorphine but are unable to inject intravenously.

Keywords: Diacetylmorphine; Heroin-assisted treatment; Nasal administration; Opioid agonist treatment; Opioid use disorder.

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Conflict of interest statement

All authors of the present manuscript declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Scheduled, realised, and missed DAM administrations over the course of 28 weeks. IV: intravenous; IM: intramuscular; *Referred to another treatment centre due to violation of HAT centre safety policies
See this image and copyright information in PMC

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