Methadone reduces treatment dropout more than buprenorphine. A JAMA study followed more than 30,000 patients treated for opioid use disorder in British Columbia. Dropout rates were 37-40% lower with methadone. Both medicines were equally safe in real-world care.
Summary: This is one of the largest studies to date. It shows that far fewer people drop out of opioid use disorder treatment on methadone than on buprenorphine. That makes methadone the better choice. Both drugs were equally safe in real-world use.
Dropout is still a major problem in treating opioid use disorder (OUD). A new study from British Columbia shows dropout rates with methadone are 37-40% lower than with buprenorphine.
The new study was published in JAMA. It is one of the largest studies to date. It looked at more than 30,000 patients treated for opioid use disorder between January 1, 2010, and March 17, 2020.
Despite the best efforts, OUD is still a major problem in the US. Opioid prescriptions have dropped in recent years. But OUD cases have not dropped as expected. That is because opioids are still widely used for chronic pain. Many people also keep using illegal opioids for their pain.
But as people learn more about the health risks of OUD, much has changed. In the US, it is now easier to get certain prescription drugs for OUD. Some can even be had through telemedicine. This makes treatment easier to reach. It also helps people get past the shame tied to the condition.
Right now there are three options for treating OUD: methadone, buprenorphine, and naltrexone. Methadone and buprenorphine are the most commonly prescribed. Even so, some questions remain. Which one is better to start with? And which one keeps more people from quitting treatment?
Methadone works amazingly well. It is an opioid too, but a much safer one. So it is excellent at shutting down withdrawal symptoms. Its big downside is access. Only federally registered Opioid Treatment Programs (OTPs) can dispense it.
Buprenorphine, on the other hand, is less tightly controlled. Commonly called “bupe,” it is a partial opioid that also cuts craving. Since December 2022, some rules have changed. Now it is easier for qualified clinicians to prescribe it. So over the years, buprenorphine has grown more popular for opioid addiction treatment.
There are reasons for the stricter rules on methadone. People living with OUD are more likely to misuse it.
But there are also worries that these strict rules may be hurting OUD treatment. Until now, there has been little evidence either way.
This new study shows methadone may be better, because far fewer people quit it. The study was long and very large. So its results apply to many parts of North America.
The study also tracked side effects in both groups. It found both drugs were equally well tolerated. Methadone was slightly more likely to cause side effects than buprenorphine. But there wasn’t any statistically significant difference between the groups.
Buprenorphine is used more widely in the US, with looser rules. One reason is the belief that it is safer. But when you judge a drug’s safety, you also have to weigh how well it works.
This study shows that in real life, methadone is not likely to cause significantly more side effects than buprenorphine. And it works much better. Policymakers must take these findings into account. They need to make methadone easier to get for opioid addiction treatment.
Frequently asked questions
Is methadone better than Suboxone for opioid use disorder?
This is 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 37-40% less often than people who started on buprenorphine, the drug in Suboxone. That lower dropout rate 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 cuts 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. Only federally registered Opioid Treatment Programs can dispense methadone. Buprenorphine is less tightly controlled. Since December 2022, it is also 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 treating opioid use disorder: methadone, buprenorphine and naltrexone. Methadone and buprenorphine are the two most commonly prescribed. Both cut craving. The JAMA study found the two equally safe in real-world use. Methadone kept more people in treatment.
Related reading
Mindfulness Cuts Opioid Treatment Dropout and Relapse · Chronic Pain and Opioid Use Disorder · No Outcome Gains with Broader NP Opioid Authority · What Is Suboxone? How It Treats Opioid Addiction
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
Sources
- Nosyk B, Min JE, Homayra F, et al. Buprenorphine/Naloxone vs Methadone for the Treatment of Opioid Use Disorder. JAMA. 2024;332(21):1822-1831. PMID 39418046 · DOI 10.1001/jama.2024.16954.
- Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2014;2014(2):CD002207. PMID 24500948 · DOI 10.1002/14651858.CD002207.pub4.