ADVERTISEMENT
Treatment Discontinuation Rates Lower With Methadone Than Buprenorphine/Naloxone
Methadone was associated with a lower risk of treatment discontinuation than buprenorphine/naloxone among patients with opioid use disorder (OUD), according to study findings published in JAMA.
“The risk of mortality while receiving treatment was similar between medications,” reported corresponding author Bohdan Nosyk, PhD, of Simon Fraser University in Burnaby, British Columbia, Canada, and study coauthors. "As the use of more potent synthetic opioids continues to increase in North America and elsewhere, clinical guidelines for all aspects of the treatment of people with opioid use disorders require reconsideration to reduce the risk of discontinuation of treatment."
Related: Adults Who Smoke Have More Chronic Pain, Use More Opioids
The population-based retrospective cohort study included patients in British Columbia who initiated treatment with buprenorphine/naloxone or methadone between January 1, 2010, and March 17, 2020. Among participants, 30,891 were first-time, or incident, users, and 25,614 were categorized as prevalent new users (for whom first and subsequent treatment attempts were included in analyses).
Within 24 months, 88.8% of incident users of buprenorphine/naloxone had discontinued treatment compared with 81.5% of incident users of methadone, according to the study. Among incident users who received treatment according to dosing guidelines, discontinuation rates were 42.1% with buprenorphine/naloxone and 30.7% with methadone.
“Estimates were smaller but still favored methadone among prevalent new users,” researchers reported.
At guideline-recommending dosing, rates of all-cause mortality within 24 months were 0.08% with buprenorphine/naloxone and 0.13% with methadone among incident users, the study found. All-cause mortality rates among prevalent users were 0.08% with buprenorphine/naloxone and 0.09% with methadone.
“These results were largely unchanged after fentanyl first appeared in the illicit drug supply, and results were consistent across patient subgroups,” researchers wrote. “Limited variation in treatment estimates were found for people with chronic pain, those younger than 25 years, those with serious mental disorders, and those previously incarcerated.”
Reference
