Long term outcomes of pharmacological treatments for opioid dependence: does methadone still lead the pack?

García-Portilla, María Paz; Bobes-Bascaran, María Teresa; Bascarán, María Teresa Bobes; Sáiz, Pilar A.; Bobes, Julio

doi:10.1111/bcp.12031

Cited by 36 publications

(21 citation statements)

References 40 publications

(56 reference statements)

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“…For many individuals, opioid use disorder is a chronic condition that requires long-term care [2]. Both methadone (MET) and buprenorphine (BUP) are effective medications for opioid use disorder [3][4][5][6][7], and are often used as maintenance treatment to stabilize opioid use on a long-term basis. [8,9] In the United States, MET is a Schedule II full agonist that can be used in Federal-and State-approved programs; BUP is a partial agonist that was approved by the US Food and Drug Administration (FDA) in 2002 and can be used in general health-care settings by qualified practitioners.…”

Section: Introductionmentioning

confidence: 99%

Long‐term outcomes after randomization to buprenorphine/naloxone versus methadone in a multi‐site trial

et al. 2016

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Aims To compare long-term outcomes among participants randomized to buprenorphine or methadone. Design/Setting/Participants Follow-up was conducted in 2011–2014 of 1,080 opioid-dependent participants entering 7 opioid treatment programs in the USA between 2006 and 2009 and randomized (within each program) to receive open-label buprenorphine/naloxone or methadone for up to 24 weeks; 795 participants completed in-person interviews (~74% follow-up interview rate) covering on average 4.5 years. Measurements Outcomes were indicated by mortality and opioid use. Covariates included demographics, site, cocaine use, and treatment experiences. Findings Mortality was not different between the two randomized conditions with 23 (3.6%) of 630 participants randomized to buprenorphine having died, versus 26 (5.8%) of 450 participants randomized to methadone. Opioid use at follow-up was higher among participants randomized to buprenorphine relative to methadone (42.8% vs. 31.7% positive opioid urine specimens, p< .01, effect size (h)=0.23 [0.09, 0.38]; 5.8 days vs. 4.4 days of past 30-day heroin use, p< .05, effect size (d)=0.14 [0.00, 0.28]). Opioid use over the follow-up period by randomization condition was also significant (F(7,39600)=3.16; p < .001) mostly due to less treatment participation among participants randomized to buprenorphine than methadone. Less opioid use was associated with both buprenorphine and methadone treatment (relative to no treatment); no difference was found between the two treatments. Individuals who are white or used cocaine at baseline responded better to methadone than to buprenorphine. Conclusions There are few differences in long-term outcomes between buprenorphine and methadone treatment for opioid dependence, and treatment with each medication is associated with a strong reduction in opioid use.

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Section: Introductionmentioning

confidence: 99%

Long‐term outcomes after randomization to buprenorphine/naloxone versus methadone in a multi‐site trial

et al. 2016

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“…The notable drop in the overall ASSIST score across all substance classes was to be expected and is supported by decades of research on the effectiveness of methadone [16,43,44,48,53,[59][60][61][62][63][64]. There was a significant increase in the use of cannabis amongst participants, however the reasons for this increase was not investigated.…”

Section: Heroin and Other Drug Usementioning

confidence: 97%

“…Most of these features are common to low threshold programmes, which show higher levels of retention than higher threshold services [17][18][19]. One of the most consistent predictors of retention is methadone dose [53][54][55]. The globally recommended daily dose range for methadone is 60-120 mg [11].…”

Section: Retentionmentioning

confidence: 99%

Six-month retention and changes in quality of life and substance use from a low-threshold methadone maintenance therapy programme in Durban, South Africa

Scheibe

Shelly

Gerardy³

et al. 2020

Addict Sci Clin Pract

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Background: Emerging data points to a potential heroin use epidemic in South Africa. Despite this, access to methadone maintenance therapy and other evidence-based treatment options remains negligible. We aimed to assess retention, changes in substance use and quality of life after 6 months on methadone maintenance therapy provided through a low-threshold service in Durban, South Africa. Methods:We enrolled a cohort of 54 people with an opioid use disorder into the study. We reviewed and described baseline socio-demographic characteristics. Baseline and 6-month substance use was assessed using the World Health Organization's Alcohol Smoking and Substance Use Involvement Screening Test (ASSIST) and quality of life, using the SF-12. We compared changes at 6 months on methadone to baseline using the Wilcoxon signed rank test and paired-tests for the ASSIST and SF-12 scores, respectively. McNemar's test was used for comparisons between paired results of categorical variables relating to injecting frequency. Results:The majority of the participants were young, Black African males, with a history of drug use spanning over 10 years. Retention after 6 months was 81%. After 6 months, the median heroin ASSIST score decreased from 37 to 9 (p < 0.0001) and the cannabis ASSIST score increased from 12.5 to 21 (p = 0.0003). The median mental health composite score of the SF-12 increased from 41.4 to 48.7 (p = 0.0254). Conclusions:Interim findings suggest high retention, significant reductions in heroin use and improvements in mental health among participants retained on methadone maintenance therapy for 6 months. Further research into longer term outcomes and the reasons contributing to these changes would strengthen recommendations for the scale-up of methadone maintenance therapy in South Africa.

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“…Methadone maintenance therapy, one of the most effective treatments for heroin dependence (Garcia-Portilla, Bobes-Bascaran, Bascaran, Saiz, & Bobes, 2014), is associated with reduced risk of HIV infection (Sorensen & Copeland, 2000). However, many patients continue to engage in HIV risk behaviors while receiving methadone treatment, especially patients who use cocaine.…”

Section: Introductionmentioning

confidence: 99%

Alcohol use disorders are associated with increased HIV risk behaviors in cocaine-dependent methadone patients

Meredith

Rash

Petry

2017

Journal of Substance Abuse Treatment

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People who inject drugs (PWID) are at increased risk of HIV infection. Although methadone maintenance therapy can help lower this risk, many methadone patients continue to engage in HIV risk behaviors, especially patients who use cocaine and alcohol. The purpose of the current study was to investigate relations between alcohol use disorders and HIV risk behavior in 239 cocaine-dependent methadone patients participating in a randomized controlled trial of a behavioral intervention to promote cocaine abstinence. Past 3-month HIV Risk-taking Behavior Scale (HRBS) scores were compared between cocaine-dependent methadone patients who met DSM-IV-TR diagnostic criteria for alcohol abuse or dependence and those who did not meet these criteria. No significant differences in HRBS drug subscale scores were observed between participants with and without alcohol use disorders, indicating risky drug use was similar between groups. However, alcohol use disorder was significantly associated with HRBS sex subscale scores (t=2.59, p=.01), indicating participants with alcohol use disorders were more likely to engage in risky sexual behavior. Item-level analyses of the sex-related HRBS questions showed participants with alcohol use disorders were significantly more likely than participants without alcohol use disorders to have unprotected sex, engage in transactional (paid) sex, and have anal sex. Interventions are needed to reduce risky sexual behavior and attenuate the spread of HIV in this high-risk population.

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Long term outcomes of pharmacological treatments for opioid dependence: does methadone still lead the pack?

Cited by 36 publications

References 40 publications

Long‐term outcomes after randomization to buprenorphine/naloxone versus methadone in a multi‐site trial

Long‐term outcomes after randomization to buprenorphine/naloxone versus methadone in a multi‐site trial

Six-month retention and changes in quality of life and substance use from a low-threshold methadone maintenance therapy programme in Durban, South Africa

Alcohol use disorders are associated with increased HIV risk behaviors in cocaine-dependent methadone patients

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