title: Long-term outcomes after randomization to buprenorphine/naloxone versus methadone in a multi-site trial.
abstract: OBJECTIVE
  To compare long-term outcomes among participants randomized to buprenorphine or methadone.
  
  
  METHODS
  Follow-up was conducted in 2011-14 of 1080 opioid-dependent participants entering seven opioid treatment programs in the United States between 2006 and 2009 and randomized (within each program) to receive open-label buprenorphine/naloxone or methadone for up to 24 weeks; 795 participants completed in-person interviews (~74% follow-up interview rate) covering on average 4.5 years.
  
  
  METHODS
  Outcomes were indicated by mortality and opioid use. Covariates included demographics, site, cocaine use and treatment experiences.
  
  
  RESULTS
  Mortality was not different between the two randomized conditions, with 23 (3.6%) of 630 participants randomized to buprenorphine having died versus 26 (5.8%) of 450 participants randomized to methadone. Opioid use at follow-up was higher among participants randomized to buprenorphine relative to methadone [42.8 versus 31.7% positive opioid urine specimens, P < 0.01, effect size (h) = 0.23 (0.09, 0.38); 5.8 days versus 4.4 days of past 30-day heroin use, P < 0.05, effect size (d) = 0.14 (0.00, 0.28)]. Opioid use during the follow-up period by randomization condition was also significant (F(7,39,600) = 3.16; P < 0.001) due mainly to less treatment participation among participants randomized to buprenorphine than methadone. Less opioid use was associated with both buprenorphine and methadone treatment (relative to no treatment); no difference was found between the two treatments. Individuals who are white or used cocaine at baseline responded better to methadone than to buprenorphine.
  
  
  CONCLUSIONS
  There are few differences in long-term outcomes between buprenorphine and methadone treatment for opioid dependence, and treatment with each medication is associated with a strong reduction in opioid use.
authors.affiliation: University of California, Los Angeles, CA, USA.
authors.forename: Yih-Ing
authors.initials: YI
authors.lastname: Hser
authors.affiliation: University of California, Los Angeles, CA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Evans
authors.affiliation: University of California, Los Angeles, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Huang
authors.affiliation: University of California, Los Angeles, CA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Weiss
authors.affiliation: Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Saxon
authors.affiliation: Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Carroll
authors.affiliation: University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: George
authors.initials: G
authors.lastname: Woody
authors.affiliation: National Institute on Drug Abuse, Bethesda, MD, USA.
authors.forename: David
authors.initials: D
authors.lastname: Liu
authors.affiliation: National Institute on Drug Abuse, Bethesda, MD, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Wakim
authors.affiliation: Emmes Corporation, Rockville, MD, USA.
authors.forename: Abigail G
authors.initials: AG
authors.lastname: Matthews
authors.affiliation: University of Washington, Seattle, WA, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Hatch-Maillette
authors.affiliation: Emmes Corporation, Rockville, MD, USA.
authors.forename: Eve
authors.initials: E
authors.lastname: Jelstrom
authors.affiliation: CODA, Inc., Portland, OR, USA.
authors.forename: Katharina
authors.initials: K
authors.lastname: Wiest
authors.affiliation: Hartford Dispensary, Hartford, CT, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: McLaughlin
authors.affiliation: University of California, Los Angeles, CA, USA.
authors.forename: Walter
authors.initials: W
authors.lastname: Ling
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000069479:Buprenorphine, Naloxone Drug Combination / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D011897:Random Allocation; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000069479:Buprenorphine, Naloxone Drug Combination; D009292:Narcotic Antagonists; D008691:Methadone
keywords: Buprenorphine; longitudinal; methadone; mortality; opioid dependence; opioid use; outcomes