Comparison of buprenorphine and methadone in the treatment of opioid dependence

Am J Psychiatry. 1994 Jul;151(7):1025-30. doi: 10.1176/ajp.151.7.1025.


Objective: This study compared the efficacy of buprenorphine and methadone in the treatment of opioid dependence.

Method: Participants (N = 164) were relatively treatment-naive, opioid-dependent applicants to a 26-week treatment program who were randomly assigned to either methadone or buprenorphine treatment. Dosing was double-blind and double-dummy. Patients were stabilized on a regimen of either methadone, 50 mg, or buprenorphine, 8 mg, with dose changes possible through week 16 of treatment. Urine samples were collected three times a week, and weekly counseling was provided.

Results: Buprenorphine (mean dose = 8.9 mg/day) and methadone (mean dose = 54 mg/day) were equally effective in sustaining retention in treatment, compliance with medication, and counseling regimens. In both groups, 56% of patients remained in treatment through the 16-week flexible dosing period. Overall opioid-positive urine sample rates were 55% and 47% for buprenorphine and methadone groups, respectively; cocaine-positive urine sample rates were 70% and 58%. Evidence was obtained for the effectiveness of dose increases in suppressing opioid, but not cocaine, use among those who received dose increases.

Conclusions: The results of this study provide further support for the utility of buprenorphine as a new medication in the treatment of opioid dependence and demonstrate efficacy equivalent to that of methadone when used during a clinically guided flexible dosing procedure.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Administration, Oral
  • Administration, Sublingual
  • Adult
  • Buprenorphine / administration & dosage
  • Buprenorphine / therapeutic use*
  • Cocaine / urine
  • Comorbidity
  • Double-Blind Method
  • Female
  • Humans
  • Male
  • Methadone / administration & dosage
  • Methadone / therapeutic use*
  • Middle Aged
  • Opioid-Related Disorders / drug therapy
  • Opioid-Related Disorders / epidemiology
  • Opioid-Related Disorders / rehabilitation*
  • Patient Compliance
  • Substance Abuse Detection
  • Substance-Related Disorders / epidemiology
  • Substance-Related Disorders / urine
  • Treatment Outcome


  • Buprenorphine
  • Cocaine
  • Methadone