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Treatment retention among patients randomized to buprenorphine/naloxone compared to methadone in a multi-site trial.
Addiction 2014; 109(1):79-87A

Abstract

AIMS

To examine patient and medication characteristics associated with retention and continued illicit opioid use in methadone (MET) versus buprenorphine/naloxone (BUP) treatment for opioid dependence.

DESIGN, SETTINGS AND PARTICIPANTS

This secondary analysis included 1267 opioid-dependent individuals participating in nine opioid treatment programs between 2006 and 2009 and randomized to receive open-label BUP or MET for 24 weeks.

MEASUREMENTS

The analyses included measures of patient characteristics at baseline (demographics; use of alcohol, cigarettes and illicit drugs; self-rated mental and physical health), medication dose and urine drug screens during treatment, and treatment completion and days in treatment during the 24-week trial.

FINDINGS

The treatment completion rate was 74% for MET versus 46% for BUP (P < 0.01); the rate among MET participants increased to 80% when the maximum MET dose reached or exceeded 60 mg/day. With BUP, the completion rate increased linearly with higher doses, reaching 60% with doses of 30-32 mg/day. Of those remaining in treatment, positive opioid urine results were significantly lower [odds ratio (OR) = 0.63, 95% confidence interval (CI) = 0.52-0.76, P < 0.01] among BUP relative to MET participants during the first 9 weeks of treatment. Higher medication dose was related to lower opiate use, more so among BUP patients. A Cox proportional hazards model revealed factors associated with dropout: (i) BUP [versus MET, hazard ratio (HR) = 1.61, CI = 1.20-2.15], (ii) lower medication dose (<16 mg for BUP, <60 mg for MET; HR = 3.09, CI = 2.19-4.37), (iii) the interaction of dose and treatment condition (those with higher BUP dose were 1.04 times more likely to drop out than those with lower MET dose, and (iv) being younger, Hispanic and using heroin or other substances during treatment.

CONCLUSIONS

Provision of methadone appears to be associated with better retention in treatment for opioid dependence than buprenorphine, as does use of provision of higher doses of both medications. Provision of buprenorphine is associated with lower continued use of illicit opioids.

Authors+Show Affiliations

University of California, Los Angeles, CA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

23961726

Citation

Hser, Yih-Ing, et al. "Treatment Retention Among Patients Randomized to Buprenorphine/naloxone Compared to Methadone in a Multi-site Trial." Addiction (Abingdon, England), vol. 109, no. 1, 2014, pp. 79-87.
Hser YI, Saxon AJ, Huang D, et al. Treatment retention among patients randomized to buprenorphine/naloxone compared to methadone in a multi-site trial. Addiction. 2014;109(1):79-87.
Hser, Y. I., Saxon, A. J., Huang, D., Hasson, A., Thomas, C., Hillhouse, M., ... Ling, W. (2014). Treatment retention among patients randomized to buprenorphine/naloxone compared to methadone in a multi-site trial. Addiction (Abingdon, England), 109(1), pp. 79-87. doi:10.1111/add.12333.
Hser YI, et al. Treatment Retention Among Patients Randomized to Buprenorphine/naloxone Compared to Methadone in a Multi-site Trial. Addiction. 2014;109(1):79-87. PubMed PMID: 23961726.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Treatment retention among patients randomized to buprenorphine/naloxone compared to methadone in a multi-site trial. AU - Hser,Yih-Ing, AU - Saxon,Andrew J, AU - Huang,David, AU - Hasson,Al, AU - Thomas,Christie, AU - Hillhouse,Maureen, AU - Jacobs,Petra, AU - Teruya,Cheryl, AU - McLaughlin,Paul, AU - Wiest,Katharina, AU - Cohen,Allan, AU - Ling,Walter, Y1 - 2013/10/09/ PY - 2013/02/05/received PY - 2013/05/08/revised PY - 2013/08/06/accepted PY - 2013/8/22/entrez PY - 2013/8/22/pubmed PY - 2015/4/9/medline KW - Buprenorphine KW - methadone KW - opiate dependence KW - treatment outcomes SP - 79 EP - 87 JF - Addiction (Abingdon, England) JO - Addiction VL - 109 IS - 1 N2 - AIMS: To examine patient and medication characteristics associated with retention and continued illicit opioid use in methadone (MET) versus buprenorphine/naloxone (BUP) treatment for opioid dependence. DESIGN, SETTINGS AND PARTICIPANTS: This secondary analysis included 1267 opioid-dependent individuals participating in nine opioid treatment programs between 2006 and 2009 and randomized to receive open-label BUP or MET for 24 weeks. MEASUREMENTS: The analyses included measures of patient characteristics at baseline (demographics; use of alcohol, cigarettes and illicit drugs; self-rated mental and physical health), medication dose and urine drug screens during treatment, and treatment completion and days in treatment during the 24-week trial. FINDINGS: The treatment completion rate was 74% for MET versus 46% for BUP (P < 0.01); the rate among MET participants increased to 80% when the maximum MET dose reached or exceeded 60 mg/day. With BUP, the completion rate increased linearly with higher doses, reaching 60% with doses of 30-32 mg/day. Of those remaining in treatment, positive opioid urine results were significantly lower [odds ratio (OR) = 0.63, 95% confidence interval (CI) = 0.52-0.76, P < 0.01] among BUP relative to MET participants during the first 9 weeks of treatment. Higher medication dose was related to lower opiate use, more so among BUP patients. A Cox proportional hazards model revealed factors associated with dropout: (i) BUP [versus MET, hazard ratio (HR) = 1.61, CI = 1.20-2.15], (ii) lower medication dose (<16 mg for BUP, <60 mg for MET; HR = 3.09, CI = 2.19-4.37), (iii) the interaction of dose and treatment condition (those with higher BUP dose were 1.04 times more likely to drop out than those with lower MET dose, and (iv) being younger, Hispanic and using heroin or other substances during treatment. CONCLUSIONS: Provision of methadone appears to be associated with better retention in treatment for opioid dependence than buprenorphine, as does use of provision of higher doses of both medications. Provision of buprenorphine is associated with lower continued use of illicit opioids. SN - 1360-0443 UR - https://www.unboundmedicine.com/medline/citation/23961726/Treatment_retention_among_patients_randomized_to_buprenorphine/naloxone_compared_to_methadone_in_a_multi_site_trial_ L2 - https://doi.org/10.1111/add.12333 DB - PRIME DP - Unbound Medicine ER -