A clinical trial of buprenorphine: Comparison with methadone in the detoxification of heroin addicts

TLDR

Forty‑five heroin‑addicted patients were randomized to receive sublingual buprenorphine (2 mg) or oral methadone (30 mg) in a double‑dummy, double‑blind 90‑day detoxification protocol that included 3 weeks of full dosing, 4 weeks of taper, and 6 weeks of placebo. The trial found no significant differences between buprenorphine and methadone in treatment retention, drug use, or symptom reports, and although methadone produced greater attenuation of opioid effects during a hydromorphone challenge, it did not increase illicit opioid abuse, indicating that buprenorphine is as acceptable and effective as methadone for detoxification. Clinical Pharmacology and Therapeutics 1988; 43:72–78.

Abstract

The efficacy of buprenorphine and methadone was compared in the outpatient detoxification of heroin addicts. Forty-five patients were randomized to receive either sublingual buprenorphine or oral methadone under double-dummy and double-blind conditions to study the pharmacology of buprenorphine in a 90-day detoxification protocol. The patients were administered either 2 mg buprenorphine or 30 mg methadone for 3 weeks followed by 4 weeks of dose reductions and 6 weeks of placebo medication. No significant between-group differences were seen on measures of treatment retention, drug use, or symptom report. During the hydromorphone challenge, methadone attenuated opioid effects to a greater extent than did buprenorphine on both physiologic (pupil constriction) and self-report measures. However, this did not result in greater abuse of illicit opioid drugs by subjects taking buprenorphine. The results of this clinical trial indicated that buprenorphine was acceptable to patients and as effective as methadone in the detoxification treatment of heroin addicts. Clinical Pharmacology and Therapeutics (1988) 43, 72–78; doi:10.1038/clpt.1988.13