title: Buprenorphine versus methadone maintenance therapy: a randomized double-blind trial with 405 opioid-dependent patients.
abstract: OBJECTIVE
  To assess the efficacy of buprenorphine compared with methadone maintenance therapy for opioid dependence in a large sample using a flexible dosing regime and the marketed buprenorphine tablet.
  
  
  METHODS
  Patients were randomized to receive buprenorphine or methadone over a 13-week treatment period in a double-blind, double-dummy trial.
  
  
  METHODS
  Three methadone clinics in Australia.
  
  
  METHODS
  Four hundred and five opioid-dependent patients seeking treatment.
  
  
  METHODS
  Patients received buprenorphine or methadone as indicated clinically using a flexible dosage regime. During weeks 1-6, patients were dosed daily. From weeks 7-13, buprenorphine patients received double their week 6 dose on alternate days.
  
  
  METHODS
  Retention in treatment, and illicit opioid use as determined by urinalysis. Self-reported drug use, psychological functioning, HIV-risk behaviour, general health and subjective ratings were secondary outcomes.
  
  
  RESULTS
  Intention-to-treat analyses revealed no significant difference in completion rates at 13 weeks. Methadone was superior to buprenorphine in time to termination over the 13-week period (Wald chi 2 = 4.371, df = 1, P = 0.037), but not separately for the single-day or alternate-day dosing phases. There were no significant between-group differences in morphine-positive urines, or in self-reported heroin or other illicit drug use. The majority (85%) of the buprenorphine patients transferred to alternate-day dosing were maintained in alternate-day dosing.
  
  
  CONCLUSIONS
  Buprenorphine did not differ from methadone in its ability to suppress heroin use, but retained approximately 10% fewer patients. This poorer retention was due possibly to too-slow induction onto buprenorphine. For the majority of patients, buprenorphine can be administered on alternate days.
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia. r.mattick@unsw.edu.au
authors.forename: Richard P
authors.initials: RP
authors.lastname: Mattick
authors.forename: Robert
authors.initials: R
authors.lastname: Ali
authors.forename: Jason M
authors.initials: JM
authors.lastname: White
authors.forename: Susannah
authors.initials: S
authors.lastname: O'Brien
authors.forename: Seija
authors.initials: S
authors.lastname: Wolk
authors.forename: Cath
authors.initials: C
authors.lastname: Danz
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D016896:Treatment Outcome
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine; D008691:Methadone