[Buprenorphine and methadone to opiate addicts--a randomized trial]

There are approximately 12,000 opioid dependants in Norway. Methadone-assisted treatment was approved in Norway in 1998, buprenorphine in 2000. This study compares the efficacy of methadone (n = 25) and buprenorphine (n = 25) assisted maintenance treatment in a group of long-term (> 10 years) opioid dependant.

After randomisation patients received either 16 mg sublingual buprenorphine or individually adjusted methadone (mean 106 mg, range 80 - 160) for 26 weeks, with a rehabilitation programme run in parallel.

After 180 days, patient retention was highest in the methadone group (85 % vs. 36 %, p < 0.0005). Days in treatment were 167 vs. 114 (95 % CI for difference 53 days (26-80), p < 0.001). Positive urine test rates for opiates (20 % vs 24 %, p < 0.01) and cannabis (33 % vs 45 %, p < 0.001) were lower in the methadone group which also had lower self-reported risk behaviour and psychological distress. However, only those on buprenorphine reported significant improvement in physical health. For older, long-term opioid dependants with significant co-morbidity and unsuccessful medication-free treatment, high-dose methadone maintenance appears to be the treatment of choice. However, in cases where methadone is poorly tolerated, buprenorphine therapy may be a good alternative.