Effectiveness of Methadone Treatment: "For more than 45 years, research has confirmed that opioid agonist therapy (ie, methadone hydrochloride) is a highly effective treatment for opioid addiction provided outside primary care.4-6"
Methadone & Buprenorphine
Data, statistics and information about conventional opioid substitution therapy including methadone, buprenorphine and naltrexone
"However, one problem markedly reduces naltrexone’s efficacy and has limited its use for treating heroin and other forms of opioid dependence worldwide: patients often do not like it and do not take it on a daily basis.
"Findings from a 24-week randomized controlled trial comparing extended-release injectable naltrexone (Vivitrol, Alkermes) to placebo in individuals with current opioid dependence have been considered in the recent indication for extended-release injectable naltrexone for the treatment of opioid dependence. In this trial, subjects having completed 30-day detoxification were recruited from 13 sites in Russia received either 380 mg intramuscular injections of extended-release naltrexone (n = 126) or placebo injection (n = 124) every 4 weeks for 24 weeks.
"Despite the ease of outpatient dosing and its ability to effectively block the euphoric effects of ?-opioid agonists, naltrexone has had limited success for relapse prevention when compared with maintenance therapy with methadone or buprenorphine.
"Originally approved for use in the treatment of opioid dependence by the United States Food and Drug administration (FDA) in 1984, naltrexone is a competitive ?-opioid receptor antagonist with negligible agonist effects, blocking euphoric and physiological effects of opioid agonists.11,12 Naltrexone does not cause the development of dependence or tolerance over time, and dosing cessation does not result in withdrawal.13
"There is evidence from published and unpublished observational studies that opiate substitution treatment is associated with an average 54% reduction in the risk of new HIV infection among people who inject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.
Levomethadyl Compared with Methadone: "It is now clear that methadone as well as LAAM can prolong the QT interval, and that instances of TdP have been reported with both agents. Screening to identify patients at risk for unacceptable degrees of QT prolongation ought to be a part of agonist treatment with any agent known to be a torsadogen. With proper screening and ECG monitoring it seems likely that arrhythmias associated with agonist therapy can be reduced substantially or prevented.
Levomethadyl (LAAM) No Longer Available For Clinical Use
Levomethadyl Compared with Methadone: "Other potential advantages of levomethadyl’s longer duration of action include reduced dispensing time and less opportunity for illegal diversion. Similar to methadone, it suppresses symptoms of withdrawal and produces cross-tolerance. Adverse effects of levomethadyl are infrequent and, when they occur, are the same as those for methadone. The average daily dose is 75 to 115 mg given 3 times per week. Treatment centers that are not open 7 d/wk dispense a larger dosage of levomethadyl before the 48-hour weekend period."