A Preliminary Study Comparing Methadone and Buprenorphine in Patients with Chronic Pain and Coexistent Opioid Addiction

Neumann, Anne M.; Blondell, Richard D.; Jaanimägi, Urmo; Giambrone, Amanda K.; Homish, Gregory G.; Lozano, Jacqueline; Kowalik, Urszula; Azadfard, Mohammadreza

doi:10.1080/10550887.2012.759872

Cited by 81 publications

(82 citation statements)

References 25 publications

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“…In our sample, attitudes towards both medications, among those who had experience with both, provided further evidence of the general favorability of buprenorphine over methadone. Finally, as others have also noted, we found that treating pain with co-occurring substance use remains a challenge both for patients and clinicians (Neumann et al, 2013; Weiss et al, 2014). …”

Section: Discussionsupporting

confidence: 67%

Methadone, buprenorphine and preferences for opioid agonist treatment: A qualitative analysis

Yarborough

Stumbo

McCarty

et al. 2016

Drug and Alcohol Dependence

133

107

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Background Patients and clinicians have begun to recognize the advantages and disadvantages of buprenorphine relative to methadone, but factors that influence choices between these two medications remain unclear. For example, we know little about how patients’ preferences and previous experiences influence treatment decisions. Understanding these issues may enhance treatment engagement and retention. Methods Adults with opioid dependence (n = 283) were recruited from two integrated health systems to participate in interviews focused on prior experiences with treatment for opioid dependence, knowledge of medication options, preferences for treatment, and experiences with treatment for chronic pain in the context of problems with opioids. Interviews were audio-recorded, transcribed verbatim, and coded using Atlas.ti. Results Our analysis revealed seven areas of consideration for opioid agonist treatment decision-making: 1) awareness of treatment options; 2) expectations and goals for duration of treatment and abstinence; 3) prior experience with buprenorphine or methadone; 4) need for accountability and structured support; 5) preference to avoid methadone clinics or associated stigma; 6) fear of continued addiction and perceived difficulty of withdrawal; and 7) pain control. Conclusion The availability of medication options increases the need for clear communication between clinicians and patients, for additional patient education about these medications, and for collaboration and patient influence over choices in treatment decision-making. Our results suggest that access to both methadone and buprenorphine will increase treatment options and patient choice and may enhance treatment adherence and outcomes.

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Section: Discussionsupporting

confidence: 67%

Methadone, buprenorphine and preferences for opioid agonist treatment: A qualitative analysis

Yarborough

Stumbo

McCarty

et al. 2016

Drug and Alcohol Dependence

133

107

View full text Add to dashboard Cite

show abstract

“…17 While buprenorphine has analgesic properties, it is not typically initiated, dosed, or directed toward pain relief in opioid-dependent persons. [21][22][23][24] Persistent pain is associated with negative substance use outcomes in persons receiving buprenorphine for opioid detoxification 25 or as maintenance treatment. 12 Unrelieved chronic pain contributes to early buprenorphine treatment termination.…”

Section: Introductionmentioning

confidence: 99%

Chronic Pain and DepressionAmong Primary Care Patients Treated with Buprenorphine

et al. 2015

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“…Misclassification of medications could occur, e.g. , benzodiazepines might be used for anticonvulsant purposes and as sleeping aid, while methadone could be used for substance-related disorders and pain control (48). Lastly, selection bias was also possible since the subjects were enrolled from four different research centers and each center, and clinician might have different opinions for defining active SRD.…”

Section: Discussionmentioning

confidence: 99%

Lipid-Lowering Therapy in HIV-Infected Patients: Relationship with Antiretroviral Agents and Impact of Substance-Related Disorders

Bednasz¹,

Luque²,

Zingman³

et al. 2016

CVP

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BACKGROUND The use of combination antiretroviral therapy (cART) has significantly decreased the morbidity and mortality associated with HIV infection. Lipid disorders, including lipodystrophy, hypertriglyceridemia, hypercholesterolemia, and dyslipidemia, remain the most commonly reported metabolic disorders among those treated with long-term cART. Mounting evidence suggests an association between drug abuse and poor glycemic control and diabetes complications. Substance related disorders (SRD) may increase the risk of metabolic syndrome. MATERIALS AND METHODS The aim of this retrospective cohort study was to examine the relationship between SRD, cART, and lipid-lowering agent use in an HIV infected population. A total of 276 subjects with HIV infection were included, 90 (33%) received lipid-lowering agents, and 31 (34%) had SRD. Patients received efavirenz or protease inhibitor-based cART for at least 6 months. Prescription information was retrieved from the medical records. The primary outcome was the use of lipid-lowering agents including statins, fibrates and fish oil. The impact of SRD and cART was assessed on the lipid-lowering agent use. RESULTS Smoking was prevalent among subjects with SRD (84% vs. 15%, p<0.001). Statins were the mainstay for the management of dyslipidemia (66%), followed by the fibrates (24%), omega-3 fatty acids (5%), nicotinic acid (3%) and the cholesterol absorption inhibitors (3%). Use of statins or fibrates was significantly higher among subjects without SRD than those with (40% vs. 23%, p=0.005). The type of cART, including efavirenz and protease inhibitors, appeared to have no significant impact on the use pattern of lipid-lowering agents. Lopinavir/r was mostly prescribed for subjects with SRD (25% vs. 8%, p=0.02). CONCLUSIONS Among HIV-infected patients, statins remain the mainstay for the management of dyslipidemia in routine clinical care, followed by fibrates. A significant high risk of metabolic disorders among patients with SRD is implicated by heavy tobacco use and prevalent lopinavir/r-based treatment. Significantly low rate of lipid-lowering agent use in this population underscores the importance of lipid disorder scrutiny and cART treatment optimization for HIV-infected patients with SRD.

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A Preliminary Study Comparing Methadone and Buprenorphine in Patients with Chronic Pain and Coexistent Opioid Addiction

Cited by 81 publications

References 25 publications

Methadone, buprenorphine and preferences for opioid agonist treatment: A qualitative analysis

Methadone, buprenorphine and preferences for opioid agonist treatment: A qualitative analysis

Chronic Pain and DepressionAmong Primary Care Patients Treated with Buprenorphine

Lipid-Lowering Therapy in HIV-Infected Patients: Relationship with Antiretroviral Agents and Impact of Substance-Related Disorders

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