Methadone buprenorphine comparison

Johnson RE, Chutuape MA, Strain EC, et al A comparison of levomethadyl acetate, buprenorphine, and methadone for opioid dependence. N EnglJ Med 343 1290-1297, 2000... 

Fudala P., Johnson R., Jaffe J. Outpatient comparison of buprenorphine and methadone maintenance. II. Effects of cocaine usage, retention time in study and missed clinical visits. In Harrison L., Ed. Problems of Drug Dependence. Natl. Inst. Mental Health Res. Monogr. 105 587, 1991. 

Outcomes in time-limited methadone treatment have generally been found to be very poor in comparison with maintenance (McGlothin Anglin 1981, Gossop et al. 2001, Magura Rosenblum 2001), although the early influential studies were typically in established maintenance candidates who had treatment restricted, rather than individuals who chose to reduce as an option within a flexible policy. For our purposes this intermediate duration of treatment, which now applies just as much to buprenorphine, is classed as slow detoxification, and is discussed in the section on detoxification from the two medications. 

The above drugs have been discussed as possible substitute treatments which are more euphoriant than methadone. The evidence relating to their use is limited in comparison to that for methadone, and they seem likely for the time being to remain relatively peripheral possibilities compared to methadone and buprenorphine. The euphoriant properties have been identified as a rationale for treatment, and this has various implications both for the individuals concerned, and in terms of overall treatment within a clinic. 

Another complication which can be expected in a methadone detoxification, seemingly more even than in other methods, is that of mood disturbances. In a comparison of methadone and buprenorphine withdrawal courses, actually in addition to carbamazepine, Seifert et al. (2005) found more tiredness, sensitivity in mood and depression in the (randomly assigned) methadone patients, which situation can lead to either tranquillizers or antidepressants being considered. 

Scott R (1990). The prevention of convulsions during benzodiazepine withdrawals. British Journal of General Practice, 40, 261 Seifert J, Metzner C, Paetzold W, Borsutzky M, Ohlmeier M, Passie T, Hauser U, Becker H, Wiese B, Emrich HM Schneider U (2005). Mood and affect during detoxification of opiate addicts a comparison of buprenorphine versus methadone. Addiction Biology, 10, 157-64... 

In a double-blind, randomized comparison of subUngual buprenorphine tablets with oral methadone in a 6-week trial in 58 patients using a flexible dosing procedure the retention rate was significantly better in those using methadone (90 versus 50%) (22). Those who completed the study had a similar number of opioid-positive urine samples, with a mean stabilization dose of 11 mg/day of buprenorphine and 70 mg/day of methadone. This study had several limitations 6 weeks is too short a period to determine any intermediate or long-term treatment outcomes, the sample size was too small, and the comparison of non-equivalent doses makes interpretation difficult. 

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