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Buprenorphine versus methadone maintenance for opioid dependence
T R Kosten1, R Schottenfeld, D Ziedonis
1Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06519.
The Journal of Nervous and Mental Disease
|June 1, 1993
Summary
This study found that higher doses of buprenorphine (6 mg) reduced illicit opioid use more effectively than lower doses (2 mg). Methadone demonstrated superior treatment retention and abstinence rates compared to buprenorphine in opioid dependence treatment.
Area of Science:
- Addiction Medicine
- Pharmacology
- Clinical Trials
Background:
- Opioid dependence remains a significant public health challenge requiring effective pharmacotherapies.
- Buprenorphine and methadone are primary medications used in opioid maintenance treatment.
- Comparative efficacy and retention data between different dosages and medications are crucial for clinical decision-making.
Purpose of the Study:
- To compare the efficacy of buprenorphine (2 mg and 6 mg) versus methadone (35 mg and 65 mg) in treating opioid dependence.
- To evaluate the impact of medication dosage on illicit opioid use, treatment retention, and withdrawal symptoms.
- To assess the comparative effectiveness of buprenorphine and methadone in achieving abstinence.
Main Methods:
- A 24-week randomized clinical trial involving 125 opioid-dependent patients.
- Patients received daily doses of buprenorphine (2 mg or 6 mg) or methadone (35 mg or 65 mg).
- Outcomes measured included illicit opioid use (self-reported and financial cost), treatment retention, and opioid-free urine screens.
Main Results:
- 6 mg buprenorphine was superior to 2 mg buprenorphine in reducing illicit opioid use and heroin abuse.
- Methadone groups showed significantly better treatment retention (20 vs. 16 weeks), higher rates of opioid-free urines (51% vs. 26%), and more frequent 3-week abstinence periods (65% vs. 27%) compared to buprenorphine.
- Illicit opioid use and associated costs decreased substantially across all groups, but remained higher with 2 mg buprenorphine.
Conclusions:
- Higher dose buprenorphine (6 mg) is more effective than lower dose (2 mg) for reducing illicit opioid use.
- Methadone demonstrated superior efficacy over buprenorphine in terms of treatment retention and achieving abstinence.
- Dosage adjustments are critical, and methadone may offer advantages for patients requiring higher levels of support and retention in opioid maintenance therapy.