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Transitioning Stable Methadone Maintenance Patients to Buprenorphine Maintenance

Salsitz, Edwin A. MD; Holden, Christopher C. MD; Tross, Susan PhD; Nugent, Ann BA

Journal of Addiction Medicine: June 2010 - Volume 4 - Issue 2 - p 88-92
doi: 10.1097/ADM.0b013e3181add3f5
Original Article

Objectives: Little data exists on psychosocially stable patients maintained long term on methadone maintenance treatment who attempt to transition their maintenance treatment to buprenorphine. The aims of this study were (1) to determine whether there is a correlation between baseline methadone maintenance dose and final buprenorphine maintenance dose, (2) to investigate subjective and objective outcomes over time in psychosocially stable opioid-dependent patients who transitioned their long-term maintenance treatment from methadone to buprenorphine.

Methods: In this retrospective study, 104 such patients on dosages of methadone 5 to 80 mg/d were offered the opportunity to convert their maintenance treatment to buprenorphine, of which 25 accepted.

Results: All patients (n = 25, 100%) who readily attempted transition to buprenorphine succeeded. A low-moderate association was found between patients' pretransfer methadone dose and posttransfer buprenorphine dose (Spearman correlation coefficient ρ = 0.46, P = 0.02). At a mean 30.3 months duration(SD 16.5), 22 patients (88%) remained on buprenorphine maintenance, 1 patient (4%) tapered off buprenorphine under clinician supervision, 1 patient (4%) died of hepatitis C, and 1 patient (4%) relapsed to cocaine and was lost to follow-up.

Conclusions: The results demonstrate a low to moderate association between methadone and buprenorphine maintenance doses, and that buprenorphine is a viable maintenance treatment for opioid dependence for psychosocially stable patients on long-term methadone maintenance dosages up to 80 mg/d.

From the Departments of Medicine (EAS) and Psychiatry (CCH); and Baron Edmond de Rothschild Chemical Dependency Institute (ST, AN), Beth Israel Medical Center, New York, NY.

Received for publication March 17, 2009; accepted May 11, 2009.

This work received no external funding.

Edwin A. Salsitz, MD, is on the Reckitt Benckiser Speaker's Panel and has received honoraria.

The study, which was approved by the Beth Israel Medical Center Institutional Review Board and was conducted at the Beth Israel Methadone Medical Maintenance (MMM) Program.

Send correspondence and reprint requests to Edwin A. Salsitz, MD, Department of Medicine, Beth Israel Medical Center, 1st Avenue, 16th Street, New York, NY 10003. E-mail: esalsitz@chpnet.org.

© 2010 American Society of Addiction Medicine