Comparison to Other Opioid Treatments

Methadone is the only other approved opioid maintenance treatment. While methadone is inexpensive and well-studied treatment and may be the appropriate treatment for certain patients, there are several advantages of buprenorphine over methadone. Buprenorphine:

• Is a Schedule III narcotic drug, while methadone is Schedule II - more tightly controlled - and is not approved for office-based treatment.
• Produces milder withdrawal symptoms than methadone and has a lower risk of overdose due to ceiling effect
• Is less likely to be diverted due to its combination with naloxone (Krantz and Mehler, 2004).

In a recent meta-analysis of research, Connock et al. (2007) found:

• For flexible doses, methadone (20-120 mg daily) had superior retention in treatment to buprenorphine (4-16 mg daily)
• no significant difference in opioid use
• level of mortality may be lower with buprenorphine
• no significant difference in rate of serious adverse events