Comparison of methadone and buprenorphine for opiate detoxification (LEEDS trial): a randomised controlled trial

Abstract

BackgroundMany opiate users require prescribed medication to help them achieve abstinence, commonly taking the form of a detoxification regime. In UK prisons, drug users are nearly universally treated for their opiate use by primary care clinicians, and once released access GP services where 40% of practices now treat drug users. There is a paucity of evidence evaluating methadone and buprenorphine (the two most commonly prescribed agents in the UK) for opiate detoxification. AimTo evaluate whether buprenorphine or methadone help to achieve drug abstinence at completion of a reducing regimen for heroin users presenting to UK prison health care for detoxification. DesignOpen-label, pragmatic, randomised controlled trial in three prison primary healthcare departments in the north of England. MethodPrisoners (n = 306) using illicit opiates were recruited and given daily sublingual buprenorphine or oral methadone, in the context of routine care, over a standard reduced regimen of not more than 20 days. The primary outcome measure was abstinence from illicit opiates at 8 days post detoxification, as indicated by urine test (self-report/clinical notes where urine sample was not feasible). Secondary outcomes were also recorded. ResultsAbstinence was ascertained for 73.7% at 8 days post detoxification (urine sample = 52.6%, self report = 15.2%, clinical notes = 5.9%). There was no statistically significant difference in the odds of achieving abstinence between methadone and buprenorphine (odds ratio [OR] = 1.69; 95% confidence interval [CI] = 0.81 to 3.51; P = 0.163). Abstinence was associated solely with whether or not the participant was still in prison at that time (15.22 times the odds; 95% CI = 4.19 to 55.28). The strongest association for lasting abstinence was abstinence at an earlier time point. ConclusionThere is equal clinical effectiveness between methadone and buprenorphine in achieving abstinence from opiates at 8 days post detoxification within prison.

Factors associated with willingness to participate in a pharmacologic addiction treatment clinical trial among people who use drugs

“…26 This may reflect that active daily users have failed other pharmacologic treatment options and are interested in exploring new therapies. Although several pharmacologic options already exist for the treatment of opioid addiction, including methadone, buprenorphine, and extended release naltrexone, 2,4,5,7,8,35 these options do not sustain abstinence in all users, 36 necessitating continued research into new medications and different formulations of existing ones. No approved pharmacologic treatment options presently exist for stimulant use disorders 14–16 and it is therefore unsurprising that individuals engaged in frequent crack-cocaine use would be eager to participate in drug treatment trials.…”

“…In the past few years, methadone, buprenorphine and naltrexone (including extended release formulations) have been extensively examined for the treatment of opioid use disorders and have all emerged as effective treatment options. 2–5 These medications have been shown to decrease illicit opioid use, and to varying degrees decrease several of the health and social harms associated with opioid addiction, such as human immunodeficiency virus (HIV) transmission and risk behaviors, hepatitis C virus transmission, risky sexual practices and arrest and imprisonment. 2,4–12 Unfortunately, current pharmacologic treatment options for stimulant dependence (e.g., cocaine and amphetamine type stimulants) are lacking 13–16 , and evidence-based therapies are desperately needed to reduce the health and social harms associated with stimulant use.…”

The effectiveness of diversion programmes for offenders using Class A drugs: a systematic review and meta-analysis

“…Similarly, the focus on non-incarcerated individuals participating in diversion programmes led to the exclusion of data from studies previously synthesised in notable reviews. For example, randomised studies of drug-using offenders in prison, such as the UK LEEDS trial (Wright et al, 2011) were not eligible for inclusion.…”

Treatment outcomes in patients with opioid use disorder initiated by prescription: a systematic review protocol

“…This entails the prescription of longer-acting opioids with less euphoric effects in order to minimize cravings and prevent withdrawal symptoms [ 12 , 13 ]. The most commonly used opioid substitutes are methadone, buprenorphine, naltrexone and suboxone® (a combination of buprenorphine and naloxone) [ 12 – 14 ]. OST has a positive impact on OUD including a variety of social and health-related factors, such as a decline in the use of illicit substances, unemployment, HIV prevalence, criminal activities and mortality [ 2 , 13 , 15 ].…”