Buprenorphine-based Regimens and Methadone for the Medical Management of Opioid Dependence: Selecting the Appropriate Drug for Treatment

Am J Addict. Nov-Dec 2010;19(6):557-68. doi: 10.1111/j.1521-0391.2010.00086.x. Epub 2010 Sep 21.

Abstract

Maintenance therapy with methadone or buprenorphine-based regimens reduces opioid dependence and associated harms. The perception that methadone is more effective than buprenorphine for maintenance treatment has been based on low buprenorphine doses and excessively slow induction regimens used in early buprenorphine trials. Subsequent studies show that the efficacy of buprenorphine sublingual tablet (Subutex®) or buprenorphine/naloxone sublingual tablet (Suboxone®) is equivalent to that of methadone when sufficient buprenorphine doses, rapid induction, and flexible dosing are used. Although methadone remains an essential maintenance therapy option, buprenorphine-based regimens increase access to care and provide safer, more appropriate treatment than methadone for some patients.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Administration, Sublingual
  • Attitude of Health Personnel
  • Buprenorphine / administration & dosage
  • Buprenorphine / adverse effects
  • Buprenorphine / poisoning
  • Buprenorphine / therapeutic use*
  • Clinical Trials as Topic
  • Dose-Response Relationship, Drug
  • Drug Overdose
  • Drug Therapy, Combination / methods
  • Humans
  • Infant, Newborn
  • Methadone / administration & dosage
  • Methadone / adverse effects
  • Methadone / poisoning
  • Methadone / therapeutic use*
  • Naloxone / therapeutic use
  • Neonatal Abstinence Syndrome / epidemiology
  • Opiate Substitution Treatment / methods*
  • Opioid-Related Disorders / drug therapy*
  • Social Stigma

Substances

  • Naloxone
  • Buprenorphine
  • Methadone