Dr. Erika Kancler
Objective: To investigate if buprenorphine/naloxone compared to methadone improves treatment retention and effectiveness among opioid dependent individuals. Design: Systematic literature review. Methods: Searches were conducted in PubMed and Scopus using the terms methadone, buprenorphine-naloxone and opioid dependence. In PubMed the following filters were applied: humans, English, randomized controlled trials and meta-analysis. Studies that had opioid dependent subjects, treatments comparing buprenorphine-naloxone and methadone and outcomes measures of treatment retention and efficacy were included. Results: Otiashvili et al. found that daily observed doses of methadone and buprenorphine-naloxone were effective in reducing illicit buprenorphine and other illicit opioid use. Kamien et al. found that maintenance treatment with 16mg of buprenorphine-naloxone reduced opioid use at a rate equivalent to that achieved with 90mg of methadone. Hser et al. found that methadone appeared to be associated with better retention in treatment for opioid dependence than buprenorphine-naloxone, as does that use of higher doses of both medications. Buprenorphine-naloxone is associated with lower continued use of illicit opioids. Conclusion: Buprenorphine-naloxone may be more effective at preventing illicit opioid use than methadone, although this is inconsistent among the three studies. Retention rates are also inconclusive with only one study demonstrating higher retention rates with methadone treatment. With buprenorphine-naloxone demonstrating a better safety profile, fewer withdrawal effects, ease of use and less divergence, we recommend buprenorphine-naloxone over methadone as a first line treatment in opioid-dependent individuals.
Cormier, DT, Tromblay, AT. Methadone versus buprenorphine-naloxone as a treatment for opioid dependent individuals. JMU Scholarly Commons Physician Assistant Capstones. http://commons.lib.jmu.edu/pacapstones/23. Published Mary 16, 2017