Buprenorphine/Naloxone and Methadone Maintenance Treatment Outcomes for Opioid Analgesic, Heroin, and Combined Users: Findings From Starting Treatment With Agonist Replacement Therapies (START)

Abstract

ABSTRACT. Objective:The objective of this secondary analysis was to explore differences in baseline clinical characteristics and opioid replacement therapy treatment outcomes by type (heroin, opioid analgesic [OA], or combined [heroin and OA]) and route (injector or non-injector) of opioid use. Method: A total of 1,269 participants (32.2% female) were randomized to receive one of two study medications (methadone or buprenorphine/naloxone [BUP]). Of these, 731 participants completed the 24-week active medication phase. Treatment outcomes were opioid use during the fi nal 30 days of treatment (among treatment completers) and treatment attrition. Results: Non-opioid substance dependence diagnoses and injecting differentiated heroin and combined users from OA users. Non-opioid substance dependence diagnoses and greater heroin use differentiated injectors from non-injectors. Further, injectors were more likely to be using at end of treatment compared with non-injectors. OA users were more likely to complete treatment compared with heroin users and combined users. Non-injectors were more likely than injectors to complete treatment. There were no interactions between type of opioid used or injection status and treatment assignment (methadone or BUP) on either opioid use or treatment attrition. Conclusions: Findings indicate that substance use severity differentiates heroin users from OA users and injectors from non-injectors. Irrespective of medication, heroin use and injecting are associated with treatment attrition and opioid misuse during treatment. These results have particular clinical interest, as there is no evidence of superiority of BUP over methadone for treating OA users versus heroin users. (J. Stud. Alcohol Drugs, 74, 605-613, 2013)

Short term health-related quality of life improvement during opioid agonist treatment

“…Characteristics of the trials and participants are described in Table 1, and results of the trials are summarized elsewhere (Potter et al, 2013; Weiss et al, 2011). The Starting Treatment with Agonist Replacement Therapies (START) trial was a 24-week multi-site phase-IV trial designed to compare OAT with methadone and buprenorphine/naloxone (suboxone®) (BUP/NX) in their effects on changes in liver enzymes among individuals dependent on heroin or prescription opioids.…”

Patterns of Abstinence or Continued Drug Use Among Methadone Maintenance Patients and Their Relation to Treatment Retention

“…Some findings have been difficult to interpret because of the failure of the investigators to distinguish between prescribed use of these medications for co-occurring conditions and their illicit use. With regard to cannabis use during MMT, one study found that dropouts were six times more likely to be using cannabis than those retained in MMT (Davstad et al 2007), although several other studies found no or positive effects of cannabis use on MMT retention and outcomes (Potter et al 2013;Schiff et al 2007;Weizman et al 2004;Epstein & Preston 2003;Best et al 1999a).…”

The management of opioid dependence during pregnancy in rural and remote settings

“…Furthermore, buprenorphine may be less effective than methadone at retaining patients in treatment if they used opioids intravenously. 21,22 Unlike methadone, Health Canada does not require an exemption to prescribe buprenorphine; however, outside of Ontario and Quebec, public funding of buprenorphine is restricted to physicians with a methadone license. 23 The buprenorphine formulation now includes naloxone, which is intended to deter misuse.…”