title: A comparison of levomethadyl acetate, buprenorphine, and methadone for opioid dependence.
abstract: BACKGROUND
  Opioid dependence is a chronic, relapsing disorder with important public health implications.
  
  
  METHODS
  In a 17-week randomized study of 220 patients, we compared levomethadyl acetate (75 to 115 mg), buprenorphine (16 to 32 mg), and high-dose (60 to 100 mg) and low-dose (20 mg) methadone as treatments for opioid dependence. Levomethadyl acetate and buprenorphine were administered three times a week. Methadone was administered daily. Doses were individualized except in the group assigned to low-dose methadone. Patients with poor responses to treatment were switched to methadone.
  
  
  RESULTS
  There were 55 patients in each group; 51 percent completed the trial. The mean (+/-SE) number of days that a patient remained in the study was significantly higher for those receiving levomethadyl acetate (89+/-6), buprenorphine (96+/-4), and high-dose methadone (105+/-4) than for those receiving low-dose methadone (70+/-4, P<0.001). Continued participation was also significantly more frequent among patients receiving high-dose methadone than among those receiving levomethadyl acetate (P=0.02). The percentage of patients with 12 or more consecutive opioid-negative urine specimens was 36 percent in the levomethadyl acetate group, 26 percent in the buprenorphine group, 28 percent in the high-dose methadone group, and 8 percent in the low-dose methadone group (P=0.005). At the time of their last report, patients reported on a scale of 0 to 100 that their drug problem had a mean severity of 35 with levomethadyl acetate, 34 with buprenorphine, 38 with high-dose methadone, and 53 with low-dose methadone (P=0.002).
  
  
  CONCLUSIONS
  As compared with low-dose methadone, levomethadyl acetate, buprenorphine, and high-dose methadone substantially reduce the use of illicit opioids.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
authors.forename: R E
authors.initials: RE
authors.lastname: Johnson
authors.forename: M A
authors.initials: MA
authors.lastname: Chutuape
authors.forename: E C
authors.initials: EC
authors.lastname: Strain
authors.forename: S L
authors.initials: SL
authors.lastname: Walsh
authors.forename: M L
authors.initials: ML
authors.lastname: Stitzer
authors.forename: G E
authors.initials: GE
authors.lastname: Bigelow
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D002047:Buprenorphine / Q000009:adverse effects / Q000627:therapeutic use*; D019970:Cocaine-Related Disorders / Q000150:complications; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008692:Methadyl Acetate / Q000009:adverse effects / Q000627:therapeutic use*; D008875:Middle Aged; D009294:Narcotics / Q000652:urine; D009293:Opioid-Related Disorders / Q000150:complications / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D009294:Narcotics; D002047:Buprenorphine; D008692:Methadyl Acetate; D008691:Methadone