Methadone maintenance therapy for opioid dependence

Methadone appears to retain patients in treatment and control the heroin use better than non-pharmacological approaches and appears to be as effective as buprenorphine.

A Cochrane review included 11 studies with a total of 1 969 subjects. Based on the meta-analysis, methadone appeared statistically significantly more effective than non-pharmacological approaches in retaining patient in treatment (for new studies RR 4.44, 95% CI 3.26 to 6.04; 4 studies; and for old studies, pre 2000 RR 3.05, 95% CI 1.75 to 5.35, statistical heterogeneity I²=75%; 3 studies) and in the suppression of heroin use as measured by self report and urine/hair analysis (RR 0.66, 95% CI 0.56 to 0.78; 6 studies), but not statistically different in criminal activity (RR 0.39, 95% CI 0.12 to 1.25; 3 studies) or mortality (RR 0.48, 95% CI 0.10 to 2.39; 4 studies).

Another Cochrane review included 6 studies with a total of 607 subjects. There was no difference between methadone and buprenorphine in self reported opioid use (RR 0.37, 95% CI 0.08 to 1.63) or opioid positive urine drug tests (RR 0.81, 95% CI 0.56 to 1.18) in 2 trials. There was low quality evidence from 3 studies of no difference in retention between buprenorphine and methadone maintenance treatment (RR 0.69, 95% CI 0.39 to 1.22).

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment).

The following decision support rules contain links to this evidence summary:

• Dosage of methadone in heroin addicts

Ədəbiyyat

1. Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev 2009;(3):CD002209.
2. Nielsen S, Larance B, Degenhardt L et al. Opioid agonist treatment for pharmaceutical opioid dependent people. Cochrane Database Syst Rev 2016;(5):CD011117.