Medications for opioid use disorder (MOUD) are highly effective, and often life-saving treatments, for patients struggling with opioid use.
Not all medications are created equal, however.
Methadone may help patients stay in treatment for longer compared to buprenorphine and naloxone, according to a new study published in JAMA.
“Methadone was associated with a lower risk of [opioid agonist treatment] (OAT) discontinuation compared with buprenorphine/naloxone,” the study’s authors wrote. “These results add to a growing evidence base consistent with methadone offering greater effectiveness in promoting sustained retention for individuals receiving OAT.”
In a study of over 30,800 patients, those who were treated with methadone spent a median of 66 days in treatment before discontinuing, while those treated with buprenorphine or naloxone stayed in care for a median of 30 days.
Both treatment options resulted in low mortality rates.
The study’s data set included data from all patients in British Columbia who received opioid agonist treatment between January 2010 and March 2020.
Methadone was found to be more effective at keeping patients in care across subgroups and throughout the introduction and proliferation of fentanyl in the illicit drug market.
These findings support previous research that suggests that methadone may be more effective at keeping patients in care than its MOUD counterparts, although past studies had limited insight into people who use fentanyl or diverse populations according to researchers.
“We right now have extensive data that suggests that methadone is a better drug than buprenorphine,” Robert Heimer, a professor of epidemiology and pharmacology at Yale University, previously told Addiction Treatment Business. “The retention rates, in clinical trials at least, seem to suggest that it’s a little better. The problem with methadone is the delivery system.”
Methadone regulations require most patients to show up in person to receive their dose. However, federal regulations released in February offered prescribers increased flexibility for take-home doses and telehealth prescribing.
The updated regulation is already changing how SUD providers deliver care. Opioid use disorder (OUD) treatment provider Pinnacle Treatment Centers began prescribing methadone via telehealth earlier this month.
Reducing barriers to care and enacting new strategies can help patients stay in treatment, the study’s authors wrote.
“Daily dosing thresholds and other aspects of clinical management that may present as barriers to sustained treatment retention, including urine drug screenings and daily witnessed medication ingestion, require reconsideration,” researchers wrote. “Strategies to improve retention, potentially including engagement of peer support workers, require dedicated focus to ensure the benefits of these life-saving medications are fully realized. Moreover, clinical protocols need to be updated to account for the increasingly prevalent use of higher-potency synthetic opioids.”