Abuse potential and analgesic efficacy of intravenous hydromorphone bolus administration among hospitalized patients with cancer pain: A double-blind, double dummy, randomized crossover trial

Background: There is much concern that opioids administered as intravenous (iv) bolus for pain relief may inadvertently increase their risk for abuse. However, there is insufficient data to support this. The authors compared the abuse liability potential, analgesic efficacy, and adverse effect profile of fast (iv push) versus slow (iv piggyback) administration of iv hydromorphone among hospitalized patients requiring iv opioids for pain. Methods: In this double-blind, double dummy, randomized, 2 × 2 crossover trial, patients with ≥4 cancer-related pain were randomly assigned to receive either iv hydromorphone 1 mg administered over 2 minutes (fast iv push) or 15 minutes (slow iv piggyback) during the first treatment period. Participants crossed over to receive the alternate treatments during the second period after a 6-hour washout period. Results: Eighty-three eligible patients were allocated to slow–fast (42, 51%) or fast–slow (41, 49%). Both treatments produced low abuse potential scores with no difference between them (mean peak Drug Effect Questionnaire “drug liking” subscale of fast [24.00] vs. slow [24.34], p =.82). A total of 92% and 94% of slow and fast iv hydromorphone recipients, respectively, had similar improvements in pain scores over 120 minutes (odds ratio, 0.67; 95% confidence interval, 0.06–5.82, p =.65). Drowsiness was more frequent with the fast than the slow rate (50% vs. 29% at 15 minutes [p =.03] and 52% vs. 31% at 60 minutes [p =.03]). Conclusions: Slow iv hydromorphone infusion resulted in similar abuse liability potential and pain improvement but less sedation than fast injection. These findings, taken together, suggest that the slow infusion may be considered as a first-line modality for iv opioid administration in hospitalized patients requiring intermittent opioids for pain.