Buprenorphine versus methadone maintenance for the treatment of opioid dependence

Aims. To evaluate the effectiveness of buprenorphine compared with methadon e maintenance therapy in opiate addicts over a treatment period of 24 weeks . Design. Subjects were randomized to receive either buprenorphine or metha done in an open, comparative study. Setting. Subjects were recruited and tr eated at the drug addiction outpatient clinic at the University of Vienna. Participants. Sixty subjects (19 females and 41 males) who met DSM-IV crite ria for opioid dependence and were seeking treatment. Intervention. Subject s received either sublingual buprenorphine (2-mg or 8-mg tablets; maximum d aily dose 8 mg) or oral methadone (racemic D -/+ L-methadone; maximum daily dose 80 mg). A stable dose was maintained following the 6-day induction ph ase. Measurement. Assessment of treatment retention and illicit substance u se (opiates, cocaine and benzodiazepines) was made by urinalysis. Findings. The retention rate was significantly better in the methadone maintained gr oup (p < 0.05) but subjects completing the study in the buprenorphine group had significantly lower rates of illicit opiate consumption (p = 0.04). Co nclusion. The results support the superiority of methadone with respect to retention rate. However, they also confirm previous reports of buprenorphin e use as an alternative in maintenance therapy for opiate addiction, sugges ting that a specific subgroup may be benefiting from buprenorphine. This is the first comparative trial to use sublingual buprenorphine tablets: previ ously published comparison studies refer to 30% solutions of buprenorphine in alcohol.