Comparison of buprenorphine and methadone in the treatment of opioid dependence.
OBJECTIVE
This study compared the efficacy of buprenorphine and methadone in the treatment of opioid dependence.


METHODS
Participants (N = 164) were relatively treatment-naive, opioid-dependent applicants to a 26-week treatment program who were randomly assigned to either methadone or buprenorphine treatment. Dosing was double-blind and double-dummy. Patients were stabilized on a regimen of either methadone, 50 mg, or buprenorphine, 8 mg, with dose changes possible through week 16 of treatment. Urine samples were collected three times a week, and weekly counseling was provided.


RESULTS
Buprenorphine (mean dose = 8.9 mg/day) and methadone (mean dose = 54 mg/day) were equally effective in sustaining retention in treatment, compliance with medication, and counseling regimens. In both groups, 56% of patients remained in treatment through the 16-week flexible dosing period. Overall opioid-positive urine sample rates were 55% and 47% for buprenorphine and methadone groups, respectively; cocaine-positive urine sample rates were 70% and 58%. Evidence was obtained for the effectiveness of dose increases in suppressing opioid, but not cocaine, use among those who received dose increases.


CONCLUSIONS
The results of this study provide further support for the utility of buprenorphine as a new medication in the treatment of opioid dependence and demonstrate efficacy equivalent to that of methadone when used during a clinically guided flexible dosing procedure.
Strain
E C
EC
Department of Psychiatry, Johns Hopkins University School of Medicine, Francis Scott Key Medical Center, Baltimore, MD 21224.
Stitzer
M L
ML
Liebson
I A
IA
Bigelow
G E
GE
D000284:Administration, Oral; D000286:Administration, Sublingual; D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage / Q000627:therapeutic use*; D003042:Cocaine / Q000652:urine; D015897:Comorbidity; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000453:epidemiology / Q000534:rehabilitation*; D010349:Patient Compliance; D015813:Substance Abuse Detection; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000652:urine; D016896:Treatment Outcome
D002047:Buprenorphine; D003042:Cocaine; D008691:Methadone