11 November 2003

Transfer to buprenorphine from methadone - another approach.

Transfer to buprenorphine from methadone - another approach.

Greenwald MK, Schuh KJ, Stine SM. Transferring Methadone-maintained Outpatients to the Buprenorphine Sublingual Tablet: A Preliminary Study. Am J Addict (2003) 12:365-374

This study shows that it is possible to transfer patients from methadone to buprenorphine after being stabilized on a dose level of 60mg daily. A single dose of 45mg and commencement of buprenorphine 8mg the next day was acceptable to most of the 5 volunteers on the several 'blinded' transfers accomplished. Another method was tested using 3 days of 30mg which was equally effective.

The authors state: "It may be feasible to transfer outpatients on methadone 60 mg/day to buprenorphine 8 mg/day s.l. tablet, although this pilot protocol needs refinements to improve tolerability and clinical efficacy."

There is a major conference on buprenorphine taking place this month at the New York Academy of Medicine, sponsored by the Edmund de Rothschild Institute of Chemical Dependency. It is entitled "Voices of Experience" Nov 17 and 18 details from: http://opiateaddictionrx.info/buprenorphine.html

Like all new drugs introduced, buprenorphine has several advantages as well as some disadvantages over existing agonist treatments, largely methadone. For most patients who are stable and content on methadone there is probably little reason to transfer to the new drug. However, for those with side effects, continued drug use, altered mood or other negative aspects, a second opinion is always worthwhile. This may involve dose alteration, changes to pick-up point, changes to take-away provisions or addition of antidepressants or other medications. In some cases it may entail a change to buprenorphine, sometimes with dramatic and gratifying results. Others may have to return to methadone which can be easily accomplished without delay in most settings (exception is the US where artificial regulations, exemptions and 'waivers' prevent doctors giving appropriate treatment in some instances).Comments by Andrew Byrne ..