Comparison of Buprenorphine and Methadone in the Treatment of Opioid Dependence

Abstract

A three-centre, randomised, double-blind study was designed to compare the efficacy and safety of buprenorphine and methadone. This was the first European study to compare these agents and was based on a previous trial performed in the US. Opioid-dependent subjects were randomised to receive either sublingual buprenorphine or oral methadone daily. Both objective and subjective measures of efficacy were monitored weekly, and safety parameters were regularly monitored over the entire six-week study. Urinalysis showed that the two treatments were similar with a slight increase in opioid-negative urines noted in both groups. The retention rate in the buprenorphine group was lower than in the methadone group, although it has been suggested that the buprenorphine dose may have been too low for some patients. None of the side effects noted were considered serious and all were attributable to chronic opioid dependence. Experience of two years substitution treatment in Fribourg suggests that initial induction onto buprenorphine allows for patients to be subgrouped before being given the most appropriate maintenance agent. Further investigation is required into the different dose-related effects of buprenorphine seen in particular subsets of addicts.

Early adoption of buprenorphine in substance abuse treatment centers: Data from the private and public sectors

“…It reduces withdrawal symptoms (Bickel & Amass, 1995;Chadderton, 2000) and blocks the effects of opiates (Mello & Mendelson, 1980). Numerous clinical trials have been conducted to confirm buprenorphine's effectiveness in the treatment of opiate dependence (Amass et al, 2004;Fischer et al, 1999;Fudula et al, 2003;Johnson et al, 2000;Johnson, Jaffe, & Fudula, 1992;Kosten, Schottenfeld, Ziedonis, & Falconi, 1993;Ling, Wesson, Charuvastra, & Klett, 1996;Lintzeris, Bell, Bammer, Jolley, & Rushworth, 2002;Pani, Maremmani, Piratsu, Tagliamonte, & Gessa, 2000;Petitjean et al, 2001;Schottenfeld, Pakes, Oliveto, Ziedonis, & Kosten, 1997;Strain, Stitzer, Liebson, & Bigelow, 1994;Uehlinger et al, 1998). The Substance Abuse and Mental Health Services Administration [SAMHSA] (2004) has published clinical practice guidelines regarding the use of buprenorphine (see also Johnson, Strain, & Amass, 2003).…”

Cross-reactivity of the CEDIA buprenorphine assay with opiates: an Austrian phenomenon?

“…Nevertheless, it is buprenorphine that has gained more and more importance in addiction treatment because the correlation between dose and therapeutic effects is not linear, indicating a ceiling on the effects in patients due to its opiate agonistic-antagonistic characteristics [7][8][9]. Buprenorphine is therefore a relatively safe substance, and its effectiveness in maintenance therapy has been proved in many studies [10][11][12][13][14][15][16][17]. It has been used in Austria as a substitution drug since 1999.…”

Use of Slow-Release Oral Morphine for the Treatment of Opioid Dependence

“…Metaanalysis has revealed that buprenorphine was signifi cantly less effective than methadone in retaining patients in treatment [27] . Low retention rates with buprenorphine may be explained by too low a dose being used during the induction period [28] . However, the relatively short duration of the present study, which lasted only 3 weeks, must be also taken into account when considering high retention rates recorded.…”