Lower risk of abandoning treatment for opioid use disorder with methadone

People with opioid use disorder were at less risk of stopping treatment when taking methadone compared to buprenorphine/naloxone, a study from the University of British Columbia suggests. “The benefits of these medications are only realized while people are using them. However, retention in OAT [opioid agonist therapy] has steadily declined over the past 13 years,” said study co-author Dr. Paxton Bach in a UBC press release. “Continuous evaluation and refinement of clinical guidance based on the strongest available evidence is vital in order to provide the best possible support to people with opioid use disorder in B.C. and around the world.” Dr. Bach is clinical assistant professor the UBC’s department of medicine and co-medical director for the B.C. Centre on Substance Use.Dr. Bach and colleagues analyzed data from 30,891 people with opioid use disorder who initiated treatment in B.C. for the first time between 2010 and March 2020. A total of 61% of the study population received methadone and 39% took buprenorphine/naloxone.The risk of abandoning treatment was lower in those who received methadone. Of those people who received methadone, 81.5% had discontinued treatment after two years, where of those taking buprenorphine/naloxone, 88.8% had discontinued treatment after two years. This risk was similar when researchers looked at people who took the correct doses as per protocol. The risk of mortality was low in both groups at less than 0.15%.Read: Precipitous withdrawal? Research shows risk is low with buprenorphine for treating opioid use disorderThe study spanned the years before and after fentanyl was in the unregulated drug supply. It was first detected in 2012 and was the primary driver of overdose deaths in 2016. Despite this shift, the finding that fewer people discontinued treatment when taking methadone compared to buprenorphine/naloxone remained consistent.“Reducing the risk of treatment discontinuation saves lives. With thousands of lives lost since the introduction of fentanyl into B.C.’s unregulated drug supply, it is important that we continue to evaluate the best available treatment options,” said first author Bohdan Nosyk, a scientist at the Centre for Advancing Health Outcomes and a professor in the faculty of health sciences at Simon Fraser University, in the press release. Previous research suggests that when people with opioid use disorder discontinue treatment, their risk of death more than doubles compared to those on treatment.The British Columbia Centre on Substance Use guideline for the clinical management of opioid use disorder doesn’t rank oral OAT medications, but does state the safety profile of buprenorphine/naloxone makes it the “favourable option.” It notes that prescribers should work with each person to decide the appropriate medication to use based on the person’s goals, treatment experience and circumstances. The oral medication options also include slow-release oral morphine. The guideline includes a decision support tool for selecting OAT.The paper was published in JAMA.Read: Prescribing safer alternatives to potentially deadly street drugs saved lives: B.C. study

Lower risk of abandoning treatment for opioid use disorder with methadone

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