A comparison of levomethadyl acetate, buprenorphine, and methadone for opioid dependence.

Background: Opioid dependence is a chronic, relapsing disorder with importa nt public health implications. Methods: In a 17-week randomized study of 220 patients, we compared levomet hadyl acetate (75 to 115 mg), buprenorphine (16 to 32 mg), and high-dose (6 0 to 100 mg) and low-dose (20 mg) methadone as treatments for opioid depend ence. Levomethadyl acetate and buprenorphine were administered three times a week. Methadone was administered daily. Doses were individualized except in the group assigned to low-dose methadone. Patients with poor responses t o treatment were switched to methadone. Results: There were 55 patients in each group; 51 percent completed the tri al. The mean (+/-SE) number of days that a patient remained in the study wa s significantly higher for those receiving levomethadyl acetate (89+/-6), b uprenorphine (96+/-4), and high-dose methadone (105+/-4) than for those rec eiving low-dose methadone (70+/-4, P<0.001). Continued participation in the study was also significantly more frequent among patients receiving high-d ose methadone than among those receiving levomethadyl acetate (P=0.02). The percentage of patients with 12 or more consecutive opioid-negative urine s pecimens was 36 percent in the levomethadyl acetate group, 26 percent in th e buprenorphine group, 28 percent in the high-dose methadone group, and 8 p ercent in the low-dose methadone group (P=0.005). At the time of their last report, patients reported on a scale of 0 to 100 that their drug problem h ad a mean severity of 35 with levomethadyl acetate, 34 with buprenorphine, 38 with high-dose methadone, and 53 with low-dose methadone (P=0.002). Conclusions: As compared with low-dose methadone, levomethadyl acetate, bup renorphine, and high-dose methadone substantially reduce the use of illicit opioids. (N Engl J Med 2000;343:1290-7.) (C) 2000, Massachusetts Medical S ociety.