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PostPosted: Mon Jun 18, 2012 10:39 am 
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http://www.druglib.com/abstract/so/soyk ... 80800.html

Found this completed study today comparing methadone and bupe. Check it out:

Quote:
Retention rate and substance use in methadone and buprenorphine maintenance therapy and predictors of outcome: results from a randomized study.

Author(s): Soyka M, Zingg C, Koller G, Kuefner H

Affiliation(s): Psychiatric Hospital, University of Munich, Munich, Germany. Michael.Soyka@pm-klinik.ch

Publication date & source: 2008-08, Int J Neuropsychopharmacol., 11(5):641-53. Epub 2008 Jan 21.

Publication type: Clinical Trial; Comparative Study; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't

This was a 6-month, randomized, flexible-dose study comparing the effects of methadone (Meth) and buprenorphine (Bup) on retention rate and substance use in a sample of 140 opioid-dependent, primarily heroin-addicted, patients who had been without opioid substitution therapy in the 4 weeks prior to the study. The major aims were to compare the efficacy of Bup and Meth in a flexible dosing regimen and to identify possible predictors of outcome. There were no major inhomogeneities between treatment groups. All patients also received standardized psychosocial interventions. Mean daily dosages after the induction phase were 44-50 mg for Meth and 9-12 mg for Bup. Results from this study indicate a favourable outcome, with an overall retention rate of 52.1% and no significant differences between treatment groups (55.3% vs. 48.4%). Substance use decreased significantly over time in both groups and was non-significantly lower in the Bup group. Predictors of outcome were length of continuous opioid use and age at onset of opioid use, although these were only significant in the Bup group. Mean dosage and other parameters were not significant predictors of outcome. Overall, the results of this study give further evidence that substitution treatment is a safe and effective treatment for drug dependence. Meth and Bup are equally effective. Duration of continuous opioid use and age at onset were found to have predictive value for negative outcome. The intensity of withdrawal symptoms showed the strongest correlation with drop-out. Future studies are warranted to further address patient profiles and outcome under different substitution regimens. (emphasis mine)


I think this sentence bears repeating: Duration of continuous opioid use and age at onset were found to have predictive value for negative outcome. This makes perfect sense to me. If a person was very young when they started using opiates and used for many, many years, that can be a predictor of a negative outcome. We often talk about recovery this and recovery that, but we haven't discussed this particular topic. Of course this study cannot explain why this happens or more importantly how to counteract or get past this negative outcome. I'm thinking it could just take some extra "recovery/remission" work and determination to change bad, unhealthy habits and improve oneself and their life as much as possible before letting go of the suboxone safety net.

Any thoughts? Do any of you think that methadone is just as effective as suboxone? According to this study it is. I have no feelings on it one way or another - I just don't know enough about it to state an opinion, but I thought it was perhaps worth discussing.

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PostPosted: Mon Jun 25, 2012 9:55 pm 
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It's really hard to say whether one drug is more effective at keeping people clean. I do feel that if everyone who is on Sub were on methadone instead, there may be marginally less people relapsing on other opioids. That's only because methadone is an agonist, and thus people get more of an agonist effect and don't feel the need to supplement their dosing as much. But that's offset by the fact that dose creep is much more of a concern with methadone.

But in terms of quality of life, buprenorphine wins hands down. And I firmly believe that if a study were to do general quality of life assessments on both medications, buprenorphine would come out in front.

These days I've come to believe that stabilising and recovering with the aid of Suboxone takes more willingness and motivation in recovery than doing the same with methadone. This is for the simple fact that on Suboxone the mu receptors aren't as stimulated, so in our addiction's eyes, being on Sub is a bit closer to being clean of all opioids. And I think it's for this reason that quality of life is better on Sub ... because a Sub patients body and mind is a little bit closer to how it was made or evolved (or "designed" :o ) to function.

I'll agree a lot with the age of onset argument. Age of onset is proving to be much more pertinent to a person's outcome with all kinds of diseases. People who start smoking in their teens have a much harder time quitting than those who start later in life. While carefully considering what direction my life should take, I recently read that people whose first episode of mental illness was in their teens have a considerably higher chance of passing on their illness to their progeny than those who had first episode in 20's. I have three big question marks next to my addiction prognosis / outcome. The fact I was an IV heroin addict, that I started at 16/17, and that I have a mental illness. (I found a cap of heroin on the sidewalk when I was 16 ... crazy me decided to smoke it, and the rest is history).

Methadone has a huge place in addiction treatment though. There are MANY people out there for whom Suboxone just isn't enough to keep their cravings at bay. There are many people out there who have no intention to get clean whatsoever, and methadone offers them the chance to keep their addiction calm until they can use again, meaning they won't have to rob people's houses to delay the sickness. Even for those that want to get clean, methadone can be the drug that gives them the foot in the door. Methadone -> Suboxone -> Naltrexone and peer support groups is a "step down" program that can potentially allow even the sickest addict to get clean.


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PostPosted: Sat Aug 04, 2012 11:23 am 
hello all im new here!! my capslock on this phone is broken so thats why all lowercase. anywho, personally ive been on both subutex and mdone. first i went with subutex. stayed on it for 3 years, started backsliding so i switched to mdone. they noth work in their own way. honestly tho, subutex actually worked better for me over mdone. im currently wanting to switch back but oh what a pain in the ass thats gonna
be. anyways im the new guy lol.


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Dr. Jeffrey Junig, M.D., Ph.D.

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