A naturalistic comparison of the effectiveness of methadone and two sublingual formulations of buprenorphine on maintenance treatment outcomes: Findings from a retrospective multisite study.

Proctor, Steven L.; Copeland, Amy L.; Kopak, Albert M.; Herschman, Philip L.; Polukhina, Nadiya

doi:10.1037/a0037550

Cited by 17 publications

(12 citation statements)

References 43 publications

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“…Additional differences in clinical, psycho-patholological and sociodemographic characteristics, as well co-morbid medical and psychiatric diagnoses, use of concomitant psychotropic medications, and healthcare service use between these two groups have been noted in previous studies (Barnett, 2009; Baxter et al, 2011; Fingerhood et al, 2014; Gerra et al, 2004; Hansen et al, 2013; Maremmani et al, 2011, 2007; Oliva et al, 2012, 2013; Proctor et al, 2014; Stein et al, 2012). However, a detailed national level comparative study of the characteristics of patients who receive each of these treatments has yet to be published despite the dramatic change in the nature of OAT utilization in the United States during the past decade.…”

Section: Introductionsupporting

confidence: 55%

Characteristics of veterans receiving buprenorphine vs. methadone for opioid use disorder nationally in the Veterans Health Administration

Manhapra

Quinones

Rosenheck

2016

Drug and Alcohol Dependence

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BACKGROUND The advent of buprenorphine as an alternative to methadone has dramatically shifted the landscape of opioid agonist therapy (OAT) for opioid use disorder (OUD). However, there is limited US national level data describing the differences between patients who are prescribed these two OAT options. METHODS From veterans with OUD diagnosis who used Veterans Health Administration services in 2012, we identified 3 mutually exclusive groups: those who received (1) buprenorphine only (n=5,670); (2) methadone only (n=6,252); or (3) both buprenorphine and methadone in the same year (n=2513). We calculated the bi-varate effect size differences (risk ratios and Cohen's d) for characteristics that differentiated these groups. Logistic regression analysis was then used to identify factors independently differentiating the groups. RESULTS Ten year increment in age (OR 0.67; 95% CI 0.64-0.70), urban residence (OR 0.26; 95% CI 0.25-0.33), and black race (OR 0.39; 95% CI 0.35-0.43) were strongly and negatively associated with odds of receiving buprenorphine compared to methadone, while medical and psychiatric comorbidities or receipt of other psychiatric medications did not demonstrate substantial differences between groups. CONCLUSIONS Differences between veterans receiving buprenorphine or methadone based OAT seems to be largely shaped by demographic characteristics rather than medical or psychiatric or service use characteristics. A clearer understanding of the reasons for racial differences could be helpful in assuring that black OUD patients are not denied the opportunity to receive buprenorphine if that is their preference.

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Section: Introductionsupporting

confidence: 55%

Characteristics of veterans receiving buprenorphine vs. methadone for opioid use disorder nationally in the Veterans Health Administration

Manhapra

Quinones

Rosenheck

2016

Drug and Alcohol Dependence

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“…Recent naturalistic data from a large study comparing the effects of methadone and BUP (both formulations) also found a higher retention rate among methadone patients than patients on BUP or BUP/NLX. 61 With respect to the two BUP formulations, patients in the BUP/NLX group showed a significantly longer average retention than the BUP group. The rates of illicit drug use at 6 months were similar across medication groups.…”

Section: Buprenorphine In Opioid Maintenance Treatment: Overviewmentioning

confidence: 92%

New developments in the management of opioid dependence: focus on sublingual buprenorphine–naloxone

Soyka¹

2015

SAR

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Opioid maintenance therapy is a well-established first-line treatment approach in opioid dependence. Buprenorphine, a partial opioid agonist, has been found by numerous studies to be an effective and safe medication in the treatment of opioid dependence. At present, buprenorphine is available as a monodrug or in a fixed 4:1 ratio combination with naloxone. A diminished risk of diversion and abuse for the buprenorphine–naloxone combination is likely but not firmly established. Conventional formulations are given sublingually to avoid the hepatic first-pass effect. A novel film tablet is available only in the US and Australia. Other novel, sustained-release formulations (implant, depot) are currently being developed and tested. Recent studies, including a Cochrane meta-analysis, suggest that the retention with buprenorphine is lower than for methadone, but that buprenorphine may be associated with less drug use. Higher doses of buprenorphine are associated with better retention rates. Buprenorphine has a ceiling effect at the opioid receptor with regard to respiratory depression, and may cause fewer fatal intoxications than methadone. Possible antidepressant effects of buprenorphine and its use in comorbid psychiatric patients has not been studied in much detail. Clinical implications are discussed.

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“…opioid agonist treatment (OAT)], coverage of OAT programmes remains low in many settings . Additionally, among those who access OAT, only a minority are retained on treatment, with some studies documenting 6‐month retention rates as low as 20% . This is concerning, as discontinuation from OAT has been associated with increased mortality risk .…”

Section: Introductionmentioning

confidence: 99%

High‐intensity cannabis use is associated with retention in opioid agonist treatment: a longitudinal analysis

et al. 2018

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Background and Aims: Cannabis use is common among people on opioid agonist treatment (OAT), causing concern for some care providers. However, there is limited and conflicting evidence on the impact of cannabis use on OAT outcomes. Given the critical role of retention in OAT in reducing opioid-related morbidity and mortality, we aimed to estimate the association of at least daily cannabis use on the likelihood of retention in treatment among people initiating OAT. As a secondary aim we tested the impacts of less frequent cannabis use. Design: Data were drawn from two community-recruited prospective cohorts of people who use illicit drugs (PWUD). Participants were followed for a median of 81 months (interquartile range: 37–130). Setting: Vancouver, Canada. Participants: 820 PWUD (58% men, 59% of Caucasian ethnicity, 32% HIV-positive) initiating OAT between December 1996 and May 2016. The proportion of women was higher among HIV-negative participants, with no other significant differences. Measurements: The primary outcome was retention in OAT, defined as remaining in OAT (methadone or buprenorphine/naloxone-based) for two consecutive six-month follow-up periods. The primary explanatory variable was cannabis use (at least daily versus less than daily) during the same six-month period. Confounders assessed included: socio-demographic characteristics, substance use patterns and social-structural exposures. Findings: In adjusted analysis, at least daily cannabis use was positively associated with retention in OAT (Adjusted Odds Ratio = 1.21, 95% Confidence Interval: 1.04–1.41). Our secondary analysis showed that compared with non-cannabis users, at least daily users had increased odds of retention in OAT (AOR = 1.20, 95% CI: 1.02 – 1.43), but not less than daily users (AOR = 1.00, 95% CI: 0.87 – 1.14). Conclusions: Among people who use illicit drugs initiating opioid agonist treatment in Vancouver, at least daily cannabis use was associated with approximately 21% greater odds of retention in treatment compared with less than daily consumption.

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A naturalistic comparison of the effectiveness of methadone and two sublingual formulations of buprenorphine on maintenance treatment outcomes: Findings from a retrospective multisite study.

Abstract: Comparable rates of illicit drug use at 6 months may be expected irrespective of maintenance medication, while increased retention may be expected for patients maintained on methadone relative to those maintained on Suboxone or Subutex.

Cited by 17 publications

References 43 publications

Characteristics of veterans receiving buprenorphine vs. methadone for opioid use disorder nationally in the Veterans Health Administration

Characteristics of veterans receiving buprenorphine vs. methadone for opioid use disorder nationally in the Veterans Health Administration

New developments in the management of opioid dependence: focus on sublingual buprenorphine–naloxone

High‐intensity cannabis use is associated with retention in opioid agonist treatment: a longitudinal analysis

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A naturalistic comparison of the effectiveness of methadone and two sublingual formulations of buprenorphine on maintenance treatment outcomes: Findings from a retrospective multisite study.

Abstract: Comparable rates of illicit drug use at 6 months may be expected irrespective of maintenance medication, while increased retention may be expected for patients maintained on methadone relative to those maintained on Suboxone or Subutex.

Cited by 17 publications

References 43 publications

Characteristics of veterans receiving buprenorphine vs. methadone for opioid use disorder nationally in the Veterans Health Administration

Characteristics of veterans receiving buprenorphine vs. methadone for opioid use disorder nationally in the Veterans Health Administration

New developments in the management of opioid dependence: focus on sublingual buprenorphine&ndash;naloxone

High‐intensity cannabis use is associated with retention in opioid agonist treatment: a longitudinal analysis

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New developments in the management of opioid dependence: focus on sublingual buprenorphine–naloxone