Retention rate and substance use in methadone and buprenorphine maintenance therapy and predictors of outcome: results from a randomized study

Abstract

This was a 6-month, randomized, flexible-dose study comparing the effects of methadone (Meth) and buprenorphine (Bup) on retention rate and substance use in a sample of 140 opioid-dependent, primarily heroin-addicted, patients who had been without opioid substitution therapy in the 4 weeks prior to the study. The major aims were to compare the efficacy of Bup and Meth in a flexible dosing regimen and to identify possible predictors of outcome. There were no major inhomogeneities between treatment groups. All patients also received standardized psychosocial interventions. Mean daily dosages after the induction phase were 44-50 mg for Meth and 9-12 mg for Bup. Results from this study indicate a favourable outcome, with an overall retention rate of 52.1% and no significant differences between treatment groups (55.3% vs. 48.4%). Substance use decreased significantly over time in both groups and was non-significantly lower in the Bup group. Predictors of outcome were length of continuous opioid use and age at onset of opioid use, although these were only significant in the Bup group. Mean dosage and other parameters were not significant predictors of outcome. Overall, the results of this study give further evidence that substitution treatment is a safe and effective treatment for drug dependence. Meth and Bup are equally effective. Duration of continuous opioid use and age at onset were found to have predictive value for negative outcome. The intensity of withdrawal symptoms showed the strongest correlation with drop-out. Future studies are warranted to further address patient profiles and outcome under different substitution regimens.

Predictors of Outcome During a 6-Month Follow-Up Among Heroin Dependent Patients Receiving Buprenorphine/Naloxone Maintenance Treatment

“…One of the important findings of the present study was that, while craving and withdrawal were higher in the group with a negative outcome, the mean dose of BN for stabilization did not differ between the groups. The mean dose of BN in the first 2 weeks was not associated with outcome, similar to the findings in patients treated with comparable mean daily doses of 9-12 mg 35,37,62 . In one observational study, initial induction doses of 16 mg were associated with better retention 38 .…”

“…Finally in a recent study Schwarz et al 28 reported that over one third (37.2%) of the sample discontinued BN maintenance treatment within the first month following induction, while 25% of the sample stayed for at least 43 months in treatment 28 . There are few studies of OMT outcomes that consider what factors might be associated with treatment dropout or what might be done to i m p r ov e d r o p o u t r a t e s. P r e -t r e a t m e n t characteristics, most consistently associated with poorer outcome among heroin dependent patients in BN maintenance treatment, include; male gender, lack of employment, younger age at onset of opioid use, more continuous and longer opioid use, use of heroin rather than other opioids as the primary drug, higher levels of psychiatric symptoms, lower levels of general functioning, poorer psychosocial functioning and more severe legal problems 14,[29][30][31][32][33][34][35][36] . However, depression was associated with treatment retention in two studies 34,37 .…”

“…However, depression was associated with treatment retention in two studies 34,37 . During treatment, predictors of negative outcomes in heroin dependents included lower doses, greater severity of withdrawal, side effects, more positive urine tests for opioids and other drugs, opioid positive drug screens at week 1, and fewer addiction counseling sessions 10,14,35,38 . This is the first report of early treatment characteristics associated with treatment outcomes among Turkish heroin dependents in BN maintenance treatment, which is the only agent that is used for maintenance treatment in Turkey.…”

Individualizing Opioid Use Disorder (OUD) Treatment: Time to Fully Embrace a Chronic Disease Model

“…For instance, medical management of OUD with buprenorphine/naloxone or methadone is often perceived as substituting one addiction for another. This misunderstanding of the contribution of medications to the overall management of OUD can lead to premature discontinuation of medication to the detriment of the patient, and thus, high rates of relapse [19,15,16,20]. Consider the Diagnostic and Statistical Manual of Mental Disorders criteria for the diagnosis of OUD (Figure 1).…”

Are the binary typology models of alcoholism valid in polydrug abusers ?

“…43 It keeps patients in treatment and decreases heroin use and related crime and health problems. 44 However, heroin users often drink alcohol excessively.…”