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Long-term outcomes after randomization to buprenorphine/naloxone versus methadone in a multi-site trial.
AIMS: To compare long-term outcomes among participants randomized to buprenorphine or methadone.
DESIGN/SETTING/PARTICIPANTS: Follow-up was conducted in 2011-2014 of 1,080 opioid-dependent participants entering 7 opioid treatment programs in the USA between 2006 and 2009 and randomized (within each program) to receive open-label buprenorphine/naloxone or methadone for up to 24 weeks; 795 participants completed in-person interviews (~74% follow-up interview rate) covering on average 4.5 years.
MEASUREMENTS: Outcomes were indicated by mortality and opioid use. Covariates included demographics, site, cocaine use, and treatment experiences.
FINDINGS: Mortality was not different between the two randomized conditions with 23 (3.6%) of 630 participants randomized to buprenorphine having died, versus 26 (5.8%) of 450 participants randomized to methadone. Opioid use at follow-up was higher among participants randomized to buprenorphine relative to methadone (42.8% vs. 31.7% positive opioid urine specimens, p < .01, effect size (h) = 0.23 [0.09, 0.38]; 5.8 days vs. 4.4 days of past 30-day heroin use, p < .05, effect size (d) = 0.14 [0.00, 0.28]). Opioid use over the follow-up period by randomization condition was also significant (F(7,39600) = 3.16; p < .001) mostly due to less treatment participation among participants randomized to buprenorphine than methadone. Less opioid use was associated with both buprenorphine and methadone treatment (relative to no treatment); no difference was found between the two treatments. Individuals who are white or used cocaine at baseline responded better to methadone than to buprenorphine.
CONCLUSIONS: There are few differences in long-term outcomes between buprenorphine and methadone treatment for opioid dependence, and treatment with each medication is associated with a strong reduction in opioid use. This article is protected by copyright. All rights reserved.
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