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Ask the Mental Health Expert Archives 2001-2004

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Opiates for OCD

Q. I was watching a television show called Extreme Conditions - Obsessive Compulsive Disorder (OCD) on the Discover Channel and learned of a physician doing a study with some of his OCD patients. He claimed that using Morphine actually enabled some OCD patients to control their compulsions. Some of his patients got relief for up to 3 days. Have you heard of such research? Do you know where I could find more information about who this doctor is, or just information about using opiates for OCD?

A. You may have in mind a Canadian psychiatrist named Warneke, who did find beneficial effects of morphine in a few patients with refractory obsessive-compulsive disorder (see L. Warneke, Canadian J Psychiatry 1997 Aug;42(6):667-8).

However, there is very little controlled research on the use of opiates in OCD, and some very obvious risks; e.g., the development of tolerance (more and more of the drug is required over time), abuse, addiction, etc.

More recently, Goldsmith et al found some benefits with the opiate analgesic, tramadol, in OCD patients (Am J Psychiatry 1999 Apr;156(4):660-661). This agent may work, indirectly, by increasing serotonin, a brain chemical known to be involved in OCD. Because there are many effective and well-established treatments for OCD--even in refractory cases--I would discourage the use of opiates for all but the most resistant cases.

March 2003

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