The recent research on the ‘comparison of methadone and buprenorphine for opiate detoxification (LEEDS trial): a randomised control trial’ raises an important point with regards to utilising buprenorphine and methadone in opiate detoxification.1
The authors quite rightly conclude equal clinical effectiveness between the two agents, a statement that is supported by previous studies.2,3
However, there are additional factors that should be considered when determining which one of the two would be best suited for purpose. There is evidence to support the use of buprenorphine over methadone, especially when taking into account the risk of morbidity and mortality.
Nielsen et al identified an increased risk of overdose and adverse outcomes associated with methadone when compared to burprenorphine.4
In addition to the increased number of adverse incidents, they also concluded that presenting signs (respiratory rate and Glasgow Coma Scale score) were lower in methadone-related attendances hence indicating a heightened risk of complications and death.
This was further supported by Bell and colleagues who concluded that buprenorphine was associated with lower overdose risk and lower mortality when compared to methadone.5
Although the cost of buprenorphine is higher than methadone,6 and the clinical effectiveness of both agents is on a par, it is worth bearing in mind the increased risk of overdose, hospital admissions, morbidity, and mortality associated with methadone, that may negate the cost difference.
- © British Journal of General Practice 2012
