Methadone & Buprenorphine

Data, statistics and information about conventional opioid substitution therapy including methadone, buprenorphine and naltrexone

Number and Characteristics of Patients Receiving Opioid Treatment Programs (OTPs) in the US

"Facilities were asked how many clients in treatment on March 31, 2016, received medication-assisted opioid therapy drugs for detoxification or maintenance purposes. MAT includes the use of methadone and buprenorphine for the treatment of opioid addiction or dependence, and the use of extended-release injectable naltrexone (Vivitrol®) for relapse prevention in opioid addiction. Methadone is available only at OTP facilities that are certified by SAMHSA’s Center for Substance Abuse Treatment.

Levomethadyl

"Levomethadyl is a synthetic µ-opioid receptor agonist that is commercially available in a liquid suspension. It is rapidly absorbed from the gastrointestinal tract, although its oral bioavailability is somewhat lower than that of methadone.87 Because of these properties, the opioid effect of levomethadyl is somewhat slower in onset than that of methadone (90 minutes), but it has a much longer duration of action (48-72 hours) and is therefore able to be dispensed 3 times per week."

Methadone, Pain Management, and Overdose

"The large contribution to mortality from oxycodone and methadone may be because of the long duration of action of methadone and OxyContin. Drug users may accidentally overdose by overlapping doses when the desired euphoric or analgesic effect is slow in coming. Abusers have learned to ingest and inject pulverized OxyContin pills, defeating the controlled-release mechanism and releasing dangerous amounts of the drug within a short time."

Effectiveness of Buprenorphine Treatment

"A number of clinical trials have established the effectiveness of buprenorphine for the maintenance treatment of opioid addiction. These have included studies that compared buprenorphine to placebo (Johnson et al. 1995; Ling et al. 1998; Fudala et al. 2003), as well as comparisons to methadone (e.g., Johnson et al. 1992; Ling et al. 1996; Pani et al. 2000; Petitjean et al. 2001; Schottenfeld et al. 1997; Strain et al. 1994a, 1994b) and to methadone and levo-alpha-acetyl-methadol (LAAM) (Johnson et al. 2000).

Buprenorphine for Maintenance or Detox

"Buprenorphine can be used for either longterm maintenance or for medically supervised withdrawal (detoxification) from opioids. The preponderance of research evidence and clinical experience, however, indicates that opioid maintenance treatments have a much higher likelihood of long-term success than do any forms of withdrawal treatment. In any event, the immediate goals in starting buprenorphine should be stabilization of the patient and abstinence from illicit opioids, rather than any arbitrary or predetermined schedule of withdrawal from the prescribed medication."

Availability of Treatment for Opioid Dependence and the "Treatment Gap"

"Nationally, in 2012, the rate of opioid abuse or dependence was 891.8 per 100,000 people aged 12 years or older compared with national rates of maximum potential buprenorphine treatment capacity and patients receiving methadone in OTPs of, respectively, 420.3 and 119.9. Among states and the District of Columbia, 96% had opioid abuse or dependence rates higher than their buprenorphine treatment capacity rates; 37% had a gap of at least 5 per 1000 people.

Methadone Treatment Associated with Reductions in Frequency of Opioid Use, Fewer Injections, and Lower Rates of HIV

"In summary, data from studies conducted in Australia, Europe, Asia and the United States have, with few exceptions, found strong associations between participation in methadone treatment and reductions in the frequency of opioid use, fewer injections and injection-related HIV risk behaviors, and lower rates of HIV prevalence and incidence. Few randomized controlled trials have been conducted due to ethical concerns regarding the random assignment of individuals to no treatment or other potentially less effective treatment modalities.

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