A comparison of levomethadyl acetate, buprenorphine, and methadone for opioid dependence.
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.
Johnson
R E
RE
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
Chutuape
M A
MA
Strain
E C
EC
Walsh
S L
SL
Stitzer
M L
ML
Bigelow
G E
GE
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
D000701:Analgesics, Opioid; D009294:Narcotics; D002047:Buprenorphine; D008692:Methadyl Acetate; D008691:Methadone