Comparison of Two Key Treatments for Opioid Use Disorder
The disorder opioid use has generated an urgent need for effective and sustained therapies. A recent study published in JAMA addresses the effectiveness of two treatments: methadone y buprenorphine/naloxone. The results indicate that methadone is associated with greater retention in treatment compared to buprenorphine/naloxone, although both treatments have similar mortality.
Study design and population
The analysis was carried out from a retrospective cohort study that included 30 891 personas treated in British Columbia, Canadabetween 2010 and 2020. The main objective was to evaluate the risk of treatment interruption and the mortality among those who started any of these treatments for opioid use disorder for the first time. Both incident and prevalent users were analyzed, and the results were evaluated after a 24-month follow-up.
Results on treatment interruption
The results showed that the 88,8 % of patients receiving buprenorphine/naloxone discontinued treatment compared to 81,5 % of those who received methadone. Adjusted analysis revealed that buprenorphine/naloxone recipients had a 1.58 times higher risk of stopping treatment compared to those who received methadone. These findings were consistent even when optimal doses were considered in the per-protocol analysis.
Mortality risk between the two treatments
As for the mortalityboth buprenorphine/naloxone and methadone had low rates during treatment, with a 0,08 % mortality in the buprenorphine/naloxone group and a 0,13 % in methadone. The difference in mortality risk was small and statistically insignificant, suggesting that both treatments are safe in terms of short-term mortality.
Clinical considerations for choosing treatment
This study highlights that, although the methadone offers better retention rates in treatment, buprenorphine/naloxone remains a viable and safe option in terms of mortality. Health professionals should consider these factors when choosing the most appropriate treatment for their patients, taking into account individual characteristics and long-term adherence. For more details, you can consult the full article at JAMA.
