Buprenorphine Versus Methadone in the Treatment of Opioid Dependence

Abstract

This article reports results for patients who completed the 16-week maintenance phase of a double-blind clinical trial comparing buprenorphine (N = 43; average dose = 9.0 mg/day sublingually) with methadone (N = 43; average dose = 54 mg/day orally) in the outpatient treatment of opioid dependence. In addition to pharmacotherapy, treatment during the clinical trial included individual counseling, weekly group therapy, and on-site medical services. Patients in both medication groups showed significant and substantial improvements over time in areas of psychosocial functioning, as assessed by the Addiction Severity Index, rates of urinalysis tests positive for opioids, and self-reports of opioid withdrawal symptoms, illicit opioid use, and cocaine use. Buprenorphine and methadone produced very similar outcomes on the wide array of outcome measures assessed, and improvements for both groups were large and occurred rapidly after treatment entry. A trend toward continued improvement in opioid-positive urines over time was noted for the buprenorphine but not the methadone group. These results provide further evidence of the efficacy of buprenorphine in the treatment of opioid dependence and provide a characterization of the time course of effects for buprenorphine and methadone. In addition, these results demonstrate the benefits of drug abuse treatment, both for drug and alcohol use and in other areas of psychosocial functioning.

Illicit Opioid Use and its Key Characteristics: A Select Overview and Evidence from a Canadian Multisite Cohort of Illicit Opioid Users (OPICAN)

“…As of 2005, buprenorphine has been licensed in Canada for use in opioid maintenance treatment (97), which will provide for some possible treatment diversification (98,99), although doubts have been raised about its additional treatment benefits. Systematic reviews indicate that the overall effectiveness of both high and low dosages of buprenorphine is less than that of methadone, particularly when treatment retention is a main outcome (100,101).…”

The adoption of medications in substance abuse treatment: Associations with organizational characteristics and technology clusters

“…Buprenorphine reduces withdrawal symptoms and blocks the effects of opiates (Walsh and Eissenberg, 2003). Numerous clinical trials have evaluated the effectiveness of buprenorphine in comparison to placebo , clonidine (Ling et al, 2005;Gowling et al, 2004;Lintzeris et al, 2002), and methadone (Johnson et al, 1992;Johnson et al, 2000;Pani et al, 2000;Schottenfeld et al, 1997;Strain et al, 1994). Although buprenorphine may not be more effective than methadone, it has three key advantages: it does not require daily dosing (Amass et al, 2001), its chemical composition reduces the likelihood of diversion (Amass et al, 2000), and federal regulations encouraging its prescription by primary care physicians may facilitate its integration into community-based treatment programs (Amass et al, 2004).…”

Interaction between buprenorphine and atazanavir or atazanavir/ritonavir

“…Both effects may diminish adherence if uncorrected (Altice et al, 1999;McCance-Katz et al, 2002;McCance-Katz et al, 2003;McCance-Katz et al, 2004;McCance-Katz, 2005). Buprenorphine (BUP) has been shown to be equivalent to methadone in the treatment of opioid-dependent patients (Strain et al, 1996). Buprenorphine/naloxone (BUP/NLX) in a 4:1 ratio is the usual formulation used in the treatment of opioid dependence in the United States [McCance-Katz, 2004].…”