Retention rate and illicit opioid use during methadone maintenance interventions: a meta-analysis.
The efficacy of methadone maintenance in opioid addiction was assessed in terms of programme retention rate and reduction of illicit opioid use by means of a meta-analysis of randomised, controlled and double blind clinical trials. The results were compared with interventions using buprenorphine and levo-acetylmethadol (LAAM). Trials were identified from the PubMed database from 1966 to December 1999 using the major medical subject headings 'methadone' and 'randomised controlled trial'. Data for a total of 1944 opioid-dependent patients from 13 studies were analysed. Sixty-four percent of patients received methadone, administered either as fixed or adjusted doses. Thus, 890 patients received > or = 50 mg/day (high dose group) and 392 were given < 50 mg/day (low dose group). Of 662 controls, 131 received placebo, 350 buprenorphine (265 at doses > or = 8 mg/day and 85 at doses < 8 mg/day) and 181 LAAM. High doses of methadone were more effective than low doses in the reduction of illicit opioid use (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.26--2.36). High doses of methadone were significantly more effective than low doses of buprenorphine (< 8 mg/day) for retention rates and illicit opioid use, but similar to high doses of buprenorphine (> or = 8 mg/day) for both parameters. Patients treated with LAAM had more risk of failure of retention than those receiving high doses of methadone (OR 1.92, 95% CI 1.32--2.78). It is proposed that in agonist-maintenance programmes, oral methadone at doses of 50 mg/day or higher is the drug of choice for opioid dependence.
Farré
Magí
M
Pharmacology Unit (Institut Municipal d'Investigacio Mèdica-IMIM), Carrer Doctor Aiguador 80, E-08003, Barcelona, Spain. mfarre@imim.es
Mas
Anna
A
Torrens
Marta
M
Moreno
Victor
V
Camí
Jordi
J
D002047:Buprenorphine / Q000627:therapeutic use; D006801:Humans; D008691:Methadone / Q000627:therapeutic use*; D008692:Methadyl Acetate / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D010352:Patient Dropouts / Q000706:statistics & numerical data*; D016032:Randomized Controlled Trials as Topic; D015813:Substance Abuse Detection; D016896:Treatment Outcome
D009294:Narcotics; D002047:Buprenorphine; D008692:Methadyl Acetate; D008691:Methadone