SEP 18, 2015 04:15 PM PDT

Risks of Methadone in Treatment for Opioid Dependence

When patients begin treatment for dependence on opioids, they are five times as likely to die in the first four weeks when they are given the most commonly used treatment, methadone, rather than with an alternative treatment, buprenorphine, according to a study by researchers at the University of Bristol, King’s College London and the National Drug and Alcohol Research Centre at UNSW in Australia
Methadone treatment can be risky in first month. 
The study, published in the Lancet Psychiatry, and reported in Drug Discovery & Development, reviewed the records of 32,033 patients who had started treatment with methadone or buprenorphine between 2001 and 2010. Those who began treatment with buprenorphine were less likely to die from any cause, including drug-related causes, in the first four weeks of treatment. Nonetheless, after four weeks there was little difference in risk of death between methadone and buprenorphine.
 
About 50,000 Australians (and more than 100,000 people in the UK) currently receive opioid pharmacotherapy treatment for dependence on heroin or other opioids. About two-thirds of these people are being treated with methadone and the remainder on buprenorphine, according to statistics from the Australian Institute of Health and Welfare. Buprenorphine is thought to be safer, because it is less likely to cause respiratory depression (breathing problems), but patients on buprenorphine are more likely to drop out of treatment than with methadone. Both of these treatments are endorsed by the World Health Organization.
 
According to Dr. Jo Kimber, one of the study’s lead authors and a researcher at the National Drug and Alcohol Research Centre UNSW and King’s College London, “Clinicians providing opioid substitution treatment face an important dilemma: which is more likely to reduce patient risk, buprenorphine or methadone? Buprenorphine is argued to have a superior safety profile to methadone but a higher drop-out rate. Our data suggest, at least at the beginning of treatment for heroin use, that buprenorphine has clear benefits over methadone in reducing mortality risk.”
 
As Professor Louisa Degenhardt at the National Drug and Alcohol Research Centre and one of the study’s authors, explained, “The findings support a stepped approach to treatment. Opioid substitution therapy is proven to be a cost effective and safe treatment for opioid dependence. It not only reduces risk of death but also involvement in crime and imprisonment.”
 
Professor Matthew Hickman, professor of public health and epidemiology at the University of Bristol, concluded, “These findings are of importance to GPs treating patients with drug-dependency problems, one way to reduce risks might be to commence treatment on buprenorphine for the first four weeks and then switch to methadone at a later stage without increased risk.”
About the Author
  • Ilene Schneider is the owner of Schneider the Writer, a firm that provides communications for health care, high technology and service enterprises. Her specialties include public relations, media relations, advertising, journalistic writing, editing, grant writing and corporate creativity consulting services. Prior to starting her own business in 1985, Ilene was editor of the Cleveland edition of TV Guide, associate editor of School Product News (Penton Publishing) and senior public relations representative at Beckman Instruments, Inc. She was profiled in a book, How to Open and Operate a Home-Based Writing Business and listed in Who's Who of American Women, Who's Who in Advertising and Who's Who in Media and Communications. She was the recipient of the Women in Communications, Inc. Clarion Award in advertising. A graduate of the University of Pennsylvania, Ilene and her family have lived in Irvine, California, since 1978.
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