Summary: One of the most extensive studies to date shows that methadone has much lower dropout rates when used to treat opioid use disorder than buprenorphine, making it a better choice. Moreover, both methadone and buprenorphine are equally safe in real-world conditions.
When treating opioid use disorder (OUD), dropout rates remain a significant issue. A new study done in British Columbia shows that dropout rates with methadone are 37-40% lower than those with buprenorphine.
The new study was published in JAMA, and it was one of the most extensive studies to date that analyzed more than 30,000 patients treated for opioid use disorder between January 1, 2010, and March 17, 2020.
Despite the best efforts, OUD remains a significant issue in the US. Although in recent years, opioid prescriptions have declined, OUD cases have not declined as expected. This is due to the widespread use of opioids for chronic pain. Further, many people continue to use illicit opioids for their pain.
However, as the awareness about the health risks of OUD increases, much has changed. In the US, now it is easier to get certain prescription drugs for OUD, and some of them even through telemedicine, thus helping enhance treatment accessibility and helping overcome the social stigma associated with the condition.
At present, there are three options for managing OUD: methadone, buprenorphine, and naltrexone. Among them, methadone and buprenorphine are the most commonly prescribed drugs for OUD. Despite their widespread use, some knowledge gaps remain, like which one is better for initiating therapy and which of these two most popular drugs is associated with lower treatment discontinuation rates.
Methadone works amazingly well since it is also an opioid but a much safer opioid. Thus, it is excellent for overcoming withdrawal symptoms. However, methadone can only be dispensed by federally registered Opioid Treatment Programs (OTPs), which is its significant downside.
On the other hand, buprenorphine is less stringently controlled. Commonly called “bupe,” it also helps reduce craving and is a partial opioid. Since December 2022, certain regulations have changed, making it easier for qualified clinicians to prescribe this drug. This means that, over the years, buprenorphine has become more popular for opioid addiction treatment.
There are reasons for more strict regulations regarding methadone, as there are greater chances of people living with OUD abusing this drug.
However, there are also worries that these stringent regulations might be having a negative impact on OUD treatment. But, to date, evidence has been mostly missing.
However, this new study shows that methadone may be better due to much lower discontinuation rates. Considering the study duration and massive sample size, the study results are generalizable to various parts of the North American continent.
The study also analyzed the incidence of adverse events in both groups, and it found that both drugs were equally well tolerated. Though methadone was slightly more likely to cause side effects compared to buprenorphine, there wasn’t any statistically significant difference between the groups.
One of the reasons for the more widespread use of buprenorphine in the US and less stringent regulations is the belief that it has a better safety profile. However, when it comes to analyzing the safety profile of any drug, it is also vital to consider its overall efficacy.
At least, this study shows that methadone, in real-life conditions, is not likely to cause significantly more side effects than buprenorphine, though it is much more effective. Hence, these findings must be taken into consideration by policymakers to ensure better methadone availability for opioid addiction treatment.
Frequently asked questions
Is methadone better than Suboxone for opioid use disorder?
In one of the largest studies to date, published in JAMA, researchers followed more than 30,000 people treated for opioid use disorder in British Columbia between 2010 and 2020. People who started on methadone dropped out of treatment 37-40% less often than people who started on buprenorphine, the drug in Suboxone. That lower dropout rate is what makes methadone the better choice.
Why do people prefer methadone over Suboxone?
Methadone is an opioid, but a much safer one, so it is excellent at shutting down withdrawal symptoms. Buprenorphine is a partial opioid that also reduces craving. In real-world use, methadone kept far more people in treatment, and it did not cause significantly more side effects than buprenorphine.
What are the disadvantages of methadone?
The biggest drawback is access. Methadone can only be dispensed by federally registered Opioid Treatment Programs, while buprenorphine is less tightly controlled and, since December 2022, easier for qualified clinicians to prescribe. Regulators keep methadone strict because of misuse concerns. Side effects ran slightly higher with methadone in the study, but the difference was not statistically significant.
What medications treat opioid use disorder?
There are three options for managing opioid use disorder: methadone, buprenorphine and naltrexone. Methadone and buprenorphine are the two most commonly prescribed, and both reduce craving. The JAMA study found the two equally safe in real-world conditions, with methadone keeping more people in treatment.
Source:
Nosyk, B., Min, J. E., Homayra, F., Kurz, M., Guerra-Alejos, B. C., Yan, R., Piske, M., Seaman, S. R., Bach, P., Greenland, S., Karim, M. E., Siebert, U., Bruneau, J., Gustafson, P., Kampman, K., Korthuis, P. T., Loughin, T., McCandless, L. C., Platt, R. W., … Socías, M. E. (2024). Buprenorphine/Naloxone vs Methadone for the Treatment of Opioid Use Disorder. JAMA. https://doi.org/10.1001/jama.2024.16954