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Methadone Shows Superior Retention Rates Compared to Buprenorphine/Naloxone for Opioid Use Disorder

• A recent study in JAMA reveals that methadone is more effective than buprenorphine/naloxone in retaining patients in opioid agonist treatment (OAT). • Patients on methadone stayed in treatment for a median of 66 days, compared to 30 days for those on buprenorphine/naloxone, highlighting methadone's potential for sustained retention. • The findings emphasize the need to reconsider barriers to treatment, such as daily dosing thresholds and urine drug screenings, to improve retention rates. • Updated regulations allowing for increased flexibility in methadone delivery, including telehealth prescriptions, may further enhance treatment accessibility and retention.

A new study published in JAMA indicates that methadone demonstrates superior effectiveness in retaining patients in treatment for opioid use disorder (OUD) compared to buprenorphine/naloxone. The research, analyzing data from over 30,800 patients in British Columbia between 2010 and 2020, reveals that individuals treated with methadone remained in opioid agonist treatment (OAT) significantly longer than those on buprenorphine/naloxone.

Enhanced Retention with Methadone

The study found that patients receiving methadone stayed in treatment for a median of 66 days before discontinuation, while those treated with buprenorphine/naloxone remained in care for a median of 30 days. This suggests a notable advantage for methadone in promoting sustained retention, even amidst the increasing prevalence of fentanyl in the illicit drug market.

Supporting Evidence and Expert Opinions

These findings align with previous research suggesting methadone's potential for greater effectiveness in patient retention. Robert Heimer, a professor of epidemiology and pharmacology at Yale University, stated, "We right now have extensive data that suggests that methadone is a better drug than buprenorphine. 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."

Addressing Barriers to Treatment

The study's authors emphasize the importance of reducing barriers to care to improve patient retention. They suggest reconsidering aspects of clinical management, such as daily dosing thresholds and urine drug screenings, that may hinder sustained treatment. Strategies like engaging peer support workers and updating clinical protocols to address the use of higher-potency synthetic opioids are also crucial.

Regulatory Changes and Telehealth

Recent federal regulations have introduced increased flexibility for take-home doses and telehealth prescribing of methadone. This shift is already influencing OUD treatment delivery, with providers like Pinnacle Treatment Centers initiating methadone prescriptions via telehealth. Such changes aim to enhance treatment accessibility and, consequently, improve retention rates for patients with opioid use disorder.
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Reference News

[1]
Methadone Outperforms Other Opioid Treatments in Keeping Patients in Care
bhbusiness.com · Oct 23, 2024

Methadone found more effective than buprenorphine/naloxone in keeping patients in opioid use disorder treatment, with lo...

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