Problems with hydromorphone prescribing as a response to the opioid crisis

Bromley discusses the problems with hydromorphone prescribing. Termed hydromorphone maintenance therapy (HMT), this practice entails hydromorphone being dispensed at a pharmacy at intervals of 1 to several days, all as take-home doses in the range of 16-24 tablets of 8 mg daily. Most patients prescribed HMT will crush and inject the tablets. The practice has not been peer-reviewed. Practitioners and funders may think that, with HMT, they can reap all the health and social benefits of supervised injectable opioid agonist treatment without excess risks at a fraction of the cost. However, it is important to look at HMT through the lenses of safety, effectiveness, risks and potential adverse changes in the larger treatment ecosystem that, while intended to reduce risks of use of illicit fentanyl, could expose people using opioids and the public to additional risks.