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Addiction. 2016 Apr;111(4):695-705. doi: 10.1111/add.13238. Epub 2016 Jan 13.

Long-term outcomes after randomization to buprenorphine/naloxone versus methadone in a multi-site trial.

Author information

1
University of California, Los Angeles, CA, USA.
2
Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
3
Yale University School of Medicine, New Haven, CT, USA.
4
University of Pennsylvania, Philadelphia, PA, USA.
5
National Institute on Drug Abuse, Bethesda, MD, USA.
6
Emmes Corporation, Rockville, MD, USA.
7
University of Washington, Seattle, WA, USA.
8
CODA, Inc., Portland, OR, USA.
9
Hartford Dispensary, Hartford, CT, USA.

Abstract

AIMS:

To compare long-term outcomes among participants randomized to buprenorphine or methadone.

DESIGN, SETTING AND PARTICIPANTS:

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.

MEASUREMENTS:

Outcomes were indicated by mortality and opioid use. Covariates included demographics, site, cocaine use and treatment experiences.

FINDINGS:

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.

KEYWORDS:

Buprenorphine; longitudinal; methadone; mortality; opioid dependence; opioid use; outcomes

PMID:
26599131
PMCID:
PMC4801718
DOI:
10.1111/add.13238
[Indexed for MEDLINE]
Free PMC Article

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