Cessation of methadone maintenance treatment using buprenorphine: transfer from methadone to buprenorphine and subsequent buprenorphine reductions.
BACKGROUND
Buprenorphine is used in the treatment of opioid dependence. Due to its pharmacology, the transfer from methadone to buprenorphine may precipitate withdrawal symptoms.


METHODS
Methadone maintained patients with clinical indicators of stability who were seeking withdrawal from methadone were recruited from three Australian states. Patients on methadone doses between 30 and 40 mg were randomised to transfer to buprenorphine by a fixed dose (transfer at 30 mg methadone) or by a variable dose induction (transfer when 'uncomfortable'). A third group of patients with methadone doses less than 30 mg were transferred to buprenorphine at their entry methadone dose. Fifty-one patients were inducted onto buprenorphine using the same dosing protocol with the first dose of 4 mg buprenorphine. Following stabilisation on buprenorphine, patients gradually reduced the buprenorphine dose to 0 mg. Withdrawal severity and drug use was monitored.


RESULTS
There were no significant difference between the transfer at 30 mg and transfer when 'uncomfortable' dosing protocols in severity of withdrawal on transfer from methadone to buprenorphine. Those on doses less than 30 mg reported significantly less withdrawal discomfort at transfer. All but one patient stabilised on buprenorphine. Thirty-eight of the 51 patients inducted onto buprenorphine reached 0 mg.


CONCLUSIONS
Transfer from methadone to buprenorphine can safely occur from doses of around 30 mg of methadone. Buprenorphine dose reductions were well tolerated. Thirty-one percent of patients were not using heroin or methadone at 1-month follow-up.
Breen
Courtney L
CL
National Drug and Alcohol Research Centre, University of New South Wales, NSW 2052, Sydney, Australia. courtney.breen@unsw.edu.au
Harris
Simon J
SJ
Lintzeris
Nicholas
N
Mattick
Richard P
RP
Hawken
Lynn
L
Bell
James
J
Ritter
Alison J
AJ
Lenné
Michael
M
Mendoza
Elizabeth
E
D000328:Adult; D002047:Buprenorphine / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008691:Methadone / Q000008:administration & dosage*; D010865:Pilot Projects; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy* / Q000523:psychology; D016896:Treatment Outcome
D002047:Buprenorphine; D008691:Methadone