August 14, 2012
Comparison of Effectiveness of Methadone vs Buprenorphine Maintenance Treatment
Andrew Saxon, M.D.
Professor and Director, Addiction Psychiatry Residency Training
University of Washington
Director, Addictions Treatment Center
VA Puget Sound Health Care System
Now that we have two FDA approved medications for opioid agonist therapy, methadone and buprenorphine, physicians may at times face a quandary about which medication to recommend for which patients. Although existing studies cannot fully answer that question, it may still be worth knowing the relative advantages and disadvantages of the two medications. To examine these issues, Dr. Saxon will describe some of the original pivotal clinical trials that directly compared the efficacy of buprenorphine treatment to methadone treatment. In general the two medications have resulted in roughly equivalent outcomes.
The session will also review the findings of the Starting Treatment with Agonist Replacement Therapies (START) study, a large multisite open label, randomized comparison of methadone and buprenorphine/naloxone for the treatment of opioid dependence. Sponsored by the National Institute on Drug Abuse Clinical Trials Network, START examined liver effects as a primary outcome and also collected data on other important variables including treatment retention and urine toxicology. The study provides both quantitative and qualitative data informative of patient response.
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