Buprenorphine vs Methadone Maintenance Treatment for Concurrent Opioid Dependence and Cocaine Abuse

doi:10.1001/archpsyc.1997.01830200041006

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Vol. 54 No. 8, August 1997

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Buprenorphine vs Methadone Maintenance Treatment for Concurrent Opioid Dependence and Cocaine Abuse

Richard S. Schottenfeld, MD; Juliana R. Pakes, MEd; Alison Oliveto, PhD; Douglas Ziedonis, MD; Thomas R. Kosten, MD

Arch Gen Psychiatry. 1997;54(8):713-720.

Abstract

Background
Buprenorphine, a partial µagonist and K-antagonist, hasbeen proposed as an alternative to methadone for maintenancetreatment of opioid dependence, especially for patients withconcurrent cocaine dependence or abuse. This study evaluatedwhether higher maintenance doses of buprenorphine and methadoneare superior to lower doses for reducing illicit opioid useand whether buprenorphine is superior to methadone for reducingcocaine use.

Methods
A total of 116 subjects were randomly assigned to 1 of 4 maintenancetreatment groups involving higher or lower daily doses of sublingualbuprenorphine (12 or 4 mg) or methadone (65 or 20 mg) in a double-blind,24-week clinical trial. Outcome measures included retentionin treatment and illicit opioid and cocaine use as determinedby urine toxicology testing and self-report.

Results
There were significant effects of maintenance treatment on ratesof illicit opioid use, but no significant differences in treatmentretention or the rates of cocaine use. The rates of opioid-positivetoxicology tests were lowest for treatment with 65 mg of methadone(45%), followed by 12 mg of buprenorphine (58%), 20 mg of methadone(72%), and 4 mg of buprenorphine (77%), with significant contrastsfound between 65 mg of methadone and both lower-dose treatmentsand between 12 mg of buprenorphine and both lower-dose treatments.

Conclusions
The results support the superiority of higher daily bupreporphineand methadone maintenance doses vs lower doses for reducingillicit opioid use, but the results do not support the superiorityof buprenorphine compared with methadone for reducing cocaineuse.

Author Affiliations

From the Department of Psychiatry, Yale University School of Medicine, and The APT Foundation, New Haven, Conn.

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