title: A Retrospective Evaluation of Inpatient Transfer from High-Dose Methadone to Buprenorphine Substitution Therapy.
abstract: The product license of buprenorphine/naloxone for opioid substitution therapy indicates reducing methadone concentrations to 30 mg or less per day for a minimum of 1 week before transferring patients to buprenorphine and no sooner than 24 hours after the last methadone dose, because of the risk of precipitated withdrawal and a corresponding high risk of relapse to opioid use. There are few studies describing high-dose methadone transfers. This retrospective case review assessed the feasibility of transferring patients on methadone doses above 30 mg/day to buprenorphine or buprenorphine/naloxone in the inpatient setting. Six of seven patients on 60-120 mg/day of methadone successfully completed the transfer, and four cases tested negative for opiates at long-term follow-up (6-15 months). This suggests that methadone transfer to buprenorphine can be performed rapidly without the need to taper methadone doses in patients indicated for a therapeutic switch. This small study is hypothesis-generating; larger, well-designed trials are needed to define a protocol that can be used routinely to improve and widen transfers to buprenorphine when indicated.
authors.affiliation: Cardiff and Vale University Health Board, Cardiff Community Addiction Unit, House 56, Cardiff Royal Infirmary, Newport Road, Cardiff CF24 0SZ, UK. Electronic address: Rossana.Oretti@wales.nhs.uk.
authors.forename: Rossana
authors.initials: R
authors.lastname: Oretti
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002047:Buprenorphine / Q000008:administration & dosage* / Q000494:pharmacology; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008691:Methadone / Q000008:administration & dosage* / Q000494:pharmacology; D009270:Naloxone / Q000008:administration & dosage* / Q000494:pharmacology; D058850:Opiate Substitution Treatment / Q000592:standards*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care
chemical_list: D000701:Analgesics, Opioid; D009270:Naloxone; D002047:Buprenorphine; D008691:Methadone
keywords: Buprenorphine/naloxone; High dose; Inpatient; Methadone; Transfer