The generic name is sustained release oral  morphine, abbreviated as SROM. SROM is a once daily morphine product used on long term opioid therapy for chronic and cancer pain. Some addiction physicians use it instead of methadone or buprenorphine in certain situations but it has the limitation that earning carries is not advised.

At BMC and the RAAM clinic we use SROM to augment methadone while we are trying to stabilize a new or restarting patient (increase their dose to the point where they no longer have withdrawal). Typically this approach this is only required in patients using powdered fentanyl analogues (PFA) because they tend to have high tolerances. If we think of the persons tolerance to opioids as an opioid deficit then people are withdrawal free and normal when the deficit is filled. The sooner we get to that point the sooner they will not be driven to continue to use to control their withdrawal.

If methadone is chosen over buprenorphine for a new or restarting patient one of the problems is that we are limited by the starting dose and increase doses of methadone because it accumulates. The blood level of a medication stabilizes after 5 half-lives. The half life of methadone is about 28 hours. Each day for the first 5-6 days the blood level of methadone goes up even though the dose remains the same. Morphine has a half life of 2-4 hours. SROM lasts 24 hours because of the delivery system (slowly dissolving beads). Morphine does not accumulate, so it is inherently safer.

What is the process for a high tolerance individual that is starting methadone? They would likely start with 30mg of methadone and some SROM which is given in applesauce and taken before the methadone. 4 days later the patient is reassessed and most likely the dose of both methadone and SROM are increased. 4 days later the methadone will likely be increased  and depending on the situation the SROM either kept the same, increased or decreased. The end plan for most would be methadone only however in some cases the SROM has to be continued if a maximum dose of methadone is reached. If the patient stops the PFA their tolerance usually drop fairly quickly, at which time the SROM can be tapered down to nothing,