Opiate Treatment with Agonists Including Methadone, Buprenorphine, and Suboxone

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31. OST and Reductions in Drug Use

Effectiveness of Opioid Substitution Treatment (OST)

"In summary, levomethadyl acetate, buprenorphine, and high-dose methadone were more effective than low-dose methadone in reducing the use of illicit opioids. As compared with low-dose methadone, levomethadyl acetate produced the longest duration of continuous abstinence; buprenorphine administered three times weekly was similar to levomethadyl acetate in terms of study retention and was similar to high-dose methadone in terms of abstinence."

Johnson, Rolley E., Pharm. D., Mary Ann Chutuape, PhD, Eric C. Strain, MD, Sharon L. Walsh, PhD, Maxine L. Stitzer, PhD, and George E. Bigelow, PhD, "A Comparison of Levomethadyl Acetate, Buprenorphine, and Methadone for Opioid Dependence," New England Journal of Medicine (Boston, MA: Massachusetts Medical Society, Nov. 2, 2000), Vol. 343, No. 18, p. 1296.
http://content.nejm.org/cgi/re...

32. Opioid Substitution Treatment and Risk of New HIV Infection Among IDUs

"There is evidence from published and unpublished observational studies that opiate substitution treatment is associated with an average 54% reduction in the risk of new HIV infection among people who inject drugs. There is weak evidence to suggest that greater benefit might be associated with longer measured duration of exposure to opiate substitution treatment. All of the eligible studies examined the impact of methadone maintenance treatment, indicating that there are few data regarding the impact of buprenorphine or other forms of non-methadone opiate substitution treatment in relation to HIV transmission. We found no evidence that methadone detoxification is associated with a reduction in the risk of HIV transmission."

MacArthur, Georgie J., et al., "Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis," BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.... (Published 4 October 2012).
http://www.bmj.com/content/345...

33. Opioid Substitution Treatment and Prevention of HIV Transmission

"The unparalleled international epidemic of injection drug use as a major cause of global HIV transmission, coupled with the research evidence supporting the efficacy of methadone treatment in decreasing drug injection and HIV transmission, and the unique pharmacological properties and potential acceptance of buprenorphine and the buprenorphine/naloxone combination, mean that the world is poised for implementation and evaluation of these treatments as a method to stem the spread of HIV."

Sullivan, Lynn, David S. Metzger, Paul J. Fudala & David A. Fiellin, "Decreasing International HIV Transmission: The Role of Expanding Access to Opioid Agonist Therapies for Injection Drug Users," Addiction, February 2005, Vol. 100, No. 2, p. 153.
http://www.ncbi.nlm.nih.gov/pu...

34. OST and Reductions in HIV-Risk Behaviors

A study reported in the March 8, 2000 edition of the Journal of the American Medical Association showed that traditional methadone maintenance therapy (MMT) is superior to both short-term and long-term detoxification treatment as a method to treat heroin dependence, concluding, "Our results confirm the usefulness of MMT in reducing heroin use and HIV risk behaviors. Illicit opioid use continued in both groups, but frequency was reduced. Results do not provide support for diverting resources from MMT into longterm detoxification."

Sees, Karen, DO, et al., "Methadone Maintenance vs. 180-Day Psychosocially Enriched Detoxification for Treatment of Opiod Dependence: A Randomized Controlled Trial", Journal of the American Medical Association, 2000, 283:1303-1310.
http://jama.jamanetwork.com/ar...

35. Methadone - 3-11-10

"Our results support the hypothesis that harm-reduction-based methadone maintenance treatment decreases the risk of natural-cause and overdose mortality. Furthermore, our data suggest that in harm- reduction-based methadone programs, being in methadone treatment is important in itself, independent of the pharmacologic effect of methadone dosage. To decrease mortality among drug users, prevention measures should be expanded for those who dropout of treatment."

Langendam, Miranda W., PhD, Giel H.A.van Brussel, MD, Roel A. Coutinho, MD, PhD, and Erik J.C. van Ameijden, PhD, "The Impact of Harm-Reduction-Based Methadone Treatment on Mortality Among Heroin Users," American Journal of Public Health (Washington, DC: American Public Health Association, May 2001), Vol. 95, No. 5, p. 779.
http://www.ncbi.nlm.nih.gov/pm...

36. Methadone - 3-12-10

"Methadone maintenance treatment (MMT) has been shown to improve life functioning and decrease heroin use; criminal behavior; drug use practices, such as needle sharing, that increase human immunodeficiency virus (HIV) risk; and HIV infection."

Sees, Karen, DO, et al., "Methadone Maintenance vs. 180-Day Psychosocially Enriched Detoxification for Treatment of Opiod Dependence: A Randomized Controlled Trial", Journal of the American Medical Association, 2000, 283:1303.
http://jama.jamanetwork.com/ar...

37. Methadone - 3-11-10

"Over the past two decades, clear and convincing evidence has been collected from multiple studies showing that effective treatment of opiate dependence markedly reduces the rates of criminal activity. Therefore, it is clear that significant amounts of crime perpetrated by opiate dependent persons are a direct consequence of untreated opiate dependence."

National Institutes of Health, Office of the Director, "NIH Consensus Statement: Effective Medical Treatment of Opiate Addiction," (U.S. Department of Health: Bethesda, MD, November 1997) Vol. 15, No. 6., p. 12.
http://consensus.nih.gov/1997/...

38. Methadone - 3-12-10

"MMT [methadone maintenance treatment] facilitates a process of gradual reduction in heroin use, reduction of syringe sharing and HIV risk, and reduction of criminal activities."

Rosenbaum, et al., "Treatment as Harm Reduction, Defunding as Harm Maximization: The Case of Methadone Maintenance," Journal of Psychoactive Drugs, 28: 241-249 (1996).

39. Methadone - 3-11-10

"Although a drug-free state represents an optimal treatment goal, research has demonstrated that this goal cannot be achieved or sustained by the majority of opiate-dependent people. However, other laudable treatment goals, including decreased drug use, reduced criminal activity, and gainful employment can be achieved by most MMT [methadone maintenance treatment] patients."

National Institutes of Health, Office of the Director, "NIH Consensus Statement: Effective Medical Treatment of Opiate Addiction," (U.S. Department of Health: Bethesda, MD, November 1997) Vol. 15, No. 6., p. 4.
http://consensus.nih.gov/1997/...

40. Methadone - 2-26-10

According to the National Institutes of Health (NIH), "Methadone maintenance treatment is effective in reducing illicit opiate drug use, in reducing crime, in enhancing social productivity, and in reducing the spread of viral diseases such as AIDS and hepatitis."

Effective Medical Treatment of Opiate Addiction. NIH Consensus Statement 1997 Nov. 17-19; 15(6): 4.
http://consensus.nih.gov/1997/...

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