title: Comparison of methadone and buprenorphine for opiate detoxification (LEEDS trial): a randomised controlled trial.
abstract: BACKGROUND
  Many opiate users require prescribed medication to help them achieve abstinence, commonly taking the form of a detoxification regime. In UK prisons, drug users are nearly universally treated for their opiate use by primary care clinicians, and once released access  GP services where 40% of practices now treat drug users. There is a paucity of evidence evaluating methadone and buprenorphine (the two most commonly prescribed agents in the UK) for opiate detoxification.
  
  
  OBJECTIVE
  To evaluate whether buprenorphine or methadone help to achieve  drug abstinence at completion of a reducing regimen for heroin users presenting to UK prison health care for detoxification.
  
  
  METHODS
  Open-label, pragmatic, randomised controlled trial in three prison primary healthcare departments in the north of England.
  
  
  METHODS
  Prisoners (n = 306) using illicit opiates were recruited and given daily sublingual buprenorphine or oral methadone, in the context of routine care, over a standard reduced regimen of not more than 20 days. The primary outcome measure was abstinence from illicit opiates at 8 days post  detoxification, as indicated by urine test (self-report/clinical notes where urine sample was not feasible). Secondary outcomes were also recorded.
  
  
  RESULTS
  Abstinence was ascertained for 73.7% at 8 days post detoxification (urine sample = 52.6%, self report = 15.2%, clinical  notes = 5.9%). There was no statistically significant difference in the odds of achieving abstinence between methadone and buprenorphine (odds ratio [OR] = 1.69; 95% confidence interval [CI] = 0.81 to 3.51; P = 0.163). Abstinence was associated solely with whether or not the participant was  still in prison at that time (15.22 times the odds; 95% CI = 4.19 to 55.28). The strongest association for lasting abstinence was abstinence at an earlier time point.
  
  
  CONCLUSIONS
  There is equal clinical effectiveness between methadone and buprenorphine in achieving abstinence  from opiates at 8 days post detoxification within prison.
authors.affiliation: NHS Leeds, based at HMP Leeds, Armley, Leeds. natwright@nhs.net
authors.forename: Nat M J
authors.initials: NM
authors.lastname: Wright
authors.forename: Laura
authors.initials: L
authors.lastname: Sheard
authors.forename: Clive E
authors.initials: CE
authors.lastname: Adams
authors.forename: Bruno J
authors.initials: BJ
authors.lastname: Rushforth
authors.forename: Wendy
authors.initials: W
authors.lastname: Harrison
authors.forename: Nicole
authors.initials: N
authors.lastname: Bound
authors.forename: Roger
authors.initials: R
authors.lastname: Hart
authors.forename: Charlotte N E
authors.initials: CN
authors.lastname: Tompkins
mesh_terms: D000284:Administration, Oral; D000286:Administration, Sublingual; D000328:Adult; D000368:Aged; D002047:Buprenorphine / Q000008:administration & dosage*; D006801:Humans; D008691:Methadone / Q000008:administration & dosage*; D008875:Middle Aged; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D011329:Prisoners / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine; D008691:Methadone