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Type: Journal article
Title: Which substitution pharmacotherapy is most effective in treating opioid dependence?
Author: Gowing, L.
Ali, R.
White, J.
Citation: Medical Journal of Australia, 2002; 176(10):493-494
Publisher: Australasian Med Publ Co Ltd
Issue Date: 2002
ISSN: 0025-729X
Statement of
Linda R. Gowing, Robert L. Ali and Jason M. White
Abstract: Design: Randomised controlled trial, double-blind. Setting: Outpatient clinic in Baltimore, United States. Participants: 220 people categorised as opioid dependent by DSM-IV;1 groups similar on demographics and drug use history. Exclusion criteria were medical and psychiatric illness requiring long-term medication, and pregnancy. Interventions: (i) Levo acetyl methadol (LAAM) at 75–115 mg, (ii) buprenorphine at 16–32 mg, (iii) methadone at 60–100 mg ("high dose"), or (iv) methadone at 20 mg ("low dose"). LAAM and buprenorphine were given three times a week, methadone daily. LAAM and methadone were given orally, buprenorphine sublingually. Participants attended the clinic daily for two weeks of dose induction, then thrice weekly with take-home doses. The scheduled duration of the trial was 17 weeks. Main outcome measures: Retention in treatment; illicit drug use; participants' global ratings of their drug problem. Main results: Days retained in the study (mean ± SE) — LAAM (i), 89 ± 6; buprenorphine (ii), 96 ± 4; "high dose" methadone (iii), 105 ± 4; "low dose" methadone (iv) 70 ± 4. Significantly more days retained for groups (i), (ii) and (iii) compared with group (iv) (P < 0.001), and group (iii) compared with group (i) (P = 0.02). Trial was completed by 53% of group (i), 58% of group (ii), 73% of group (iii), and 20% of group (iv), with 4, 3, 6 and 26 of groups (i), (ii), (iii) and (iv), respectively, transferred to rescue treatment (standard methadone maintenance). Twelve or more consecutive opioid-negative urine specimens were obtained in 36% of group (i), 26% of group (ii), 28% of group (iii) and 8% of group (iv) (P < 0.005). Conclusion: Compared with low-dose methadone, LAAM, buprenorphine and high-dose methadone substantially reduce the use of illicit opioids.
Keywords: Humans; Opioid-Related Disorders; Methadone; Methadyl Acetate; Buprenorphine; Analgesics, Opioid
Description: The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.
RMID: 0020022385
DOI: 10.5694/j.1326-5377.2002.tb04523.x
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Appears in Collections:Pharmacology publications

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