Buprenorphine/naloxone versus methadone in opioid dependence: a longitudinal survey.
2011
Background and Objectives: Buprenorphine and methadone are widely used for the treatment of opioid dependence, but their diversion and/or misuse are frequent. In princi- ple, buprenorphine/naloxone combination thera- py should be associated with a lower frequency of drug abuse/misuse than methadone. This study assessed the efficacy of the substitution of buprenorphine treatment with the buprenor- phine/naloxone combination in opioid-depen- dent patients. Material and Methods: 3812 drug-addicted outpatients selected from 10 Italian Public Ser- vices for Addiction (Ser.T.) centres in Naples (Italy) were enrolled: 3105 (81.5%) were treated with methadone and 707 (18.5%) with buprenor- phine. The buprenorphine treatment was switched to buprenorphine/naloxone (4:1), and the patients were followed for about 1 year. The number of subjects still on treatment after 1 year, their status according to social, education- al and toxicologic (assessed by a urine toxicolo- gy test) parameters were assessed. Results: 1 year after the therapy switch, the number of patients still on treatment was simi- larly reduced with methadone (2883; -7.5%) and buprenorphine/naloxone (632; -10.6%; p=0.369). However, in patients treated with buprenor- phine/naloxone, a significant improvement was reported in social life status (63% versus 39% of the buprenorphine/naloxone and methadone treated subjects, respectively, were mar- ried/cohabiting p<0.001), in the educational level (43% of buprenorphine/naloxone treated versus 32% of the methadone treated subjects obtained at least a high school certificate, p<0.001) and in the toxicological conditions (53% of buprenor- phine/naloxone treated subject versus 30% of methadone treated individuals had opioid- and cocaine- negative urine tests, p<0.001) .
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