Methadone Maintenance Therapy for Opioid Dependence

A Cochrane review [Abstract] 1 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 [Abstract] 2 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 http://www.ebmeds.org/ebmeds/ebmeds_home.asp?mode=scripts&submode=view&id=scr00542&country=UK

References

• 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. [PubMed]
• Nielsen S, Larance B, Degenhardt L et al. Opioid agonist treatment for pharmaceutical opioid dependent people. Cochrane Database Syst Rev 2016;(5):CD011117.[PubMed]