Kadian® Program

Kadian is an opioid agonist indicated for the management of pain severe enough to require daily, around-the-clock, long-term opioid treatment and for which alternative treatment options are inadequate.

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Opioid Agonist Therapy (OAT) includes medications like Kadian®, which is a less harmful alternative to illegal opioids like heroin, oxycodone, and fentanyl. Kadian® is another treatment option to consider if you have not benefited from Suboxone® or Methadone Treatment. Kadian® is a relatively new approach to severe opioid addiction.

Kadian® is a form of slow release oral morphine (SROM).  It is a pure selective mu (µ) opioid receptor agonist. 

Kadian® can be used off-label, for the treatment of opioid use disorder (OUD).

• A hypersensitivity or allergy to morphine sulfate or one of the non-medicinal ingredients.
• Acute respiratory depression, asthma with severe bronchospasm, severe chronic obstructive pulmonary disease (COPD).
• Gastrointestinal obstruction, including paralytic ileus.
• Concomitant use, or use within the last 14 days, of a monoamine oxidase inhibitor (MAOI).
• Significant acute intoxication with a central nervous system depressant (an opioid, alcohol, benzodiazepines, etc.).
• Patients identified with an alcohol use disorder (AUD).

• The patient must be over 18 years of age.
• The patient must have a diagnosis of opioid use disorder (OUD) as described in the DSM-5.

Kadian® is a slow-release morphine, released into your system to counteract withdrawal symptoms and stop cravings for opioids. Kadian® lasts longer than regular morphine and does not have a ceiling effect like Suboxone®. Patients are watched closely by doctors when they first start treatment until the correct dosage is reached. Kadian® can be increased at a faster rate than methadone to achieve the right dose in one to two weeks.

All these OAT medications stop withdrawal symptoms and prevent cravings. Suboxone® is usually the first treatment option because it is the safest. Methadone has been the primary OAT treatment for several decades, and studies have shown that more people stay on Methadone than Suboxone®.

Kadian® is a good treatment option for severe opioid addiction, or when you have not benefited from Suboxone® or Methadone. Kadian®, in some cases, stops cravings and improves mental health more effectively than Methadone.

These factors all depend on your situation and what your needs are. A consultation with your doctor will give you more clarity on what option is best for you.

Kadian® can be used on its own, or it can be given in conjunction with methadone at the beginning of treatment.  This makes the initiation phase easier to handle as a result of the two variations in peak plasma levels as mentioned earlier.  Individuals already on methadone can add an appropriate quantity to the methadone, if they are exhibiting withdrawal.  If they so desire, the opportunity exists to make the switch from Suboxone or methadone maintenance treatment.  Treatment retention within OAT while using Kadian® is thought to be similar to that of methadone and buprenorphine naloxone (Suboxone®). 

SROM has a lesser impact on cardiac QTc interval as compared to methadone, thereby being safe on the cardiovascular system. SROM seems to lead to fewer heroin cravings than methadone. 

Yes, you can overdose on Kadian®.  The major adverse effects of SROM are the same as those associated with other opioids: respiratory depression leading to respiratory arrest, severe bradycardia, cardiac arrest, altered consciousness leading to lethargy, and status epilepticus.

The most common adverse effects are constipation, nausea, vomiting, dyspepsia, abdominal pain, urinary retention, drowsiness, headache, dizziness, hypotension, sweating, dysphoria and insomnia.

• Kadian® use, like the use of other opioids, can lead to opioid-induced hyperalgesia.  If this occurs, the dose should be tapered, and an alternative opioid used.
• Chronic use of SROM, much like chronic use of other opioids, may also be associated with endocrine disorders such as adrenal insufficiency and hypogonadism.
• Injected-related risks associated with SROM include a rapid increase in serum morphine levels, which is associated with an increased risk of lethal intoxication. Because SROM is less soluble than heroin and other fast-acting prescription opioids, its injection carries a greater risk of infection, embolism and vascular injury.
• Drug interactions are possible.  The following is a shortened list of medications that may cause a problem (please refer to the Kadian® monograph for all known drug interactions): Central nervous system depressants, serotonergic drugs, naltrexone, monoamine oxidase inhibitors, diuretics, antihypertensives, Efavirenz, Ritonavir, P-glycoprotein inhibitors and Rifampicin.

Unsupervised doses or “carries” might be offered upon weighing the benefits against the anticipated risks. This means that even in the presence of a certain level of risk, it may be deemed appropriate to offer unsupervised dosing of Kadian® if this can improve autonomy, quality of life, adherence, and retention, given the logistics required by opioid addiction treatment (OAT) – regular visits to a pharmacy and clinic, transportation time…etc.  One must remember that overdose from SROM is possible particularly if the patient does not adhere to the prescribed dose, or attempts to alter Kadian by crushing the beads followed by intravenous injection.

The tapering process is a slow one and should be supported by your doctor. Current guidelines recommend tapering slowly over a year or more (likely no more than 10% of your daily dose every two weeks, often less). You may experience withdrawal symptoms during tapering, which is why you should be honest with your doctor about your symptoms. If you feel overwhelmed, it would be better to move at a slower pace. Tapering too fast can lead to relapse. Your personal life and your support system must be stable and strong to give yourself a better opportunity for recovery.

Clinic visits with the doctor are fully paid for if you have a valid OHIP card.

In general, costs of medications may be covered under government plans such as Ontario Drug Benefits (ODB) or Non-Insured Health Benefits (NHIB), a private medical plan, or Trillium Drug Plan (TDP). Your pharmacist may try to assist you if you are having difficulty with payment.

Set up an intake appointment by contacting us by telephone or on-line as shown below. You can also drop by a RTR clinic and present your OHIP card. An initial appointment will be scheduled as soon as possible.

To become a patient you must:

• Be 18 years of age or older
• Have valid photo identification,including a valid OHIP number
• Opioid use disorder evidence must be present as per DSM-V criteria
• Agree to follow program policies & procedures
• Give full consent prior to starting medication assisted treatment (to be agreed upon and signed by the patient)