Methadone Tied to Lower Risk for Discontinuation Versus Buprenorphine/Naloxone
FRIDAY, Oct. 18, 2024 -- Receipt of methadone for opioid use disorder is associated with a lower risk for treatment discontinuation compared with buprenorphine/naloxone, according to a study published online Oct. 17 in the Journal of the American Medical Association.
Bohdan Nosyk, Ph.D., from Simon Fraser University in Burnaby, British Columbia, Canada, and colleagues assessed the risk for treatment discontinuation and mortality among individuals receiving buprenorphine/naloxone versus methadone for the treatment of opioid use disorder. The analysis included 30,891 incident adult users (2010 to 2020) who were not incarcerated, pregnant, or receiving palliative cancer care.
The researchers found that incident users of buprenorphine/naloxone had a higher risk for treatment discontinuation versus methadone in initiator analyses (88.8 versus 81.5 percent discontinued at 24 months; adjusted hazard ratio [HR], 1.58). Similar results were found when evaluated at optimal dose in a per-protocol analysis (42.1 versus 30.7 percent; adjusted HR, 1.67). Mortality while receiving treatment showed ambiguous results in per-protocol analyses (incident users: 0.08 versus 0.13 percent mortality at 24 months; adjusted HR, 0.57; 95 percent confidence interval [CI], 0.24 to 1.35; prevalent users: 0.08 versus 0.09 percent; adjusted HR, 0.97; 95 percent CI, 0.54 to 1.73). Similar results were seen after the introduction of fentanyl and across patient subgroups.
“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,” the authors write.
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