title: A naturalistic comparison of the effectiveness of methadone and two sublingual formulations of buprenorphine on maintenance treatment outcomes: findings from a retrospective multisite study.
abstract: OBJECTIVE
  This study sought to compare the effectiveness of the 3 most commonly prescribed maintenance medications in the United States indicated for the treatment of opioid dependence in reducing illicit drug use and retaining patients in treatment.
  
  
  METHODS
  Data were abstracted from electronic medical records for 3,233 patients admitted to 34 maintenance treatment facilities located throughout the United States during the period of July 1, 2012, through July 1, 2013. Patients were grouped into 1 of 3 medication categories based on their selection at intake (methadone [n = 2,738; M dosage = 64.64 mg/d, SD = 25.58], Suboxone [n = 102; M dosage = 9.75 mg/d, SD = 4.04], or Subutex [n = 393; M dosage = 12.21 mg/d, SD = 5.31]) and were studied through retrospective chart review for 6 months or until treatment discharge. Two measures of patient retention in treatment and urinalysis drug screen (UDS) findings for both opioids and various nonopioid substances comprised the study outcomes.
  
  
  RESULTS
  The average length of stay (LOS) in terms of days in treatment for the methadone group (M = 169.86, SE = 5.02) was significantly longer than both the Subutex (M = 69.34, SE = 23.43) and Suboxone (M = 119.35, SE = 20.82) groups. The Suboxone group evinced a significantly longer average LOS relative to the Subutex group. After adjustment for relevant covariates, patients maintained on methadone were 3.73 times (95% confidence interval [CI]= 2.82-4.92) and 2.48 times (95% CI = 1.57-3.92) more likely to be retained in treatment at 6 months than patients prescribed Subutex and Suboxone, respectively. The 6-month prevalence rates of positive UDS findings for both opioids and nonopioid substances were similar across medication groups.
  
  
  CONCLUSIONS
  Comparable rates of illicit drug use at 6 months may be expected irrespective of maintenance medication, while increased retention may be expected for patients maintained on methadone relative to those maintained on Suboxone or Subutex.
authors: Department of Psychology, Louisiana State University.
authors: Steven L
authors: SL
authors: Proctor
authors: Department of Psychology, Louisiana State University.
authors: Amy L
authors: AL
authors: Copeland
authors: Department of Criminology and Criminal Justice, Western Carolina University.
authors: Albert M
authors: AM
authors: Kopak
authors: CRC Health Group, Inc.
authors: Philip L
authors: PL
authors: Herschman
authors: CRC Health Group, Inc.
authors: Nadiya
authors: N
authors: Polukhina
mesh_terms: D000286:Administration, Sublingual; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000704:Analysis of Variance; D002047:Buprenorphine / Q000008:administration & dosage*; D002626:Chemistry, Pharmaceutical / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D016482:Urinalysis; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine; D008691:Methadone