Methadone

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:

View ReferencesHide References
Connock, M, Juarez-Garcia, , Jowett, S, Frew, E, Liu, Z, Taylor, RJ, Fry-Smith, A, Day, E, Lintzeris, N, Roberts, T, Burls, A, Taylor, RS. Methadone and buprenorphine for the management of opioid dependence: a systematic review and economic evaluation. Health Technology Assessment. 2007; 11(9): .
Krantz M, Mehler P. Treating opioid dependence . Archives of Internal Medicine. 2004 ; 164(3) : 277-288. Available at: https://www.ncbi.nlm.nih.gov/pubmed/14769623 Accessed on: 2013-12-04.
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Description: 
A systematic review and economic evaluation of methadone and buprenorphine for the management of opioid dependence.
Source: 
Health Technology Assessment; Vol 11: number 9. Connock et al., 2007.
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Description: 
This 2007 article study examined the quality of life of heroin-dependent patients being treated with methadone vs. heroin-dependent patients being treated with buprenorphine.
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American Journal of Drug and Alcohol Abuse
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Description: 
This 2003 study found that buprenorphine and methadone were equally as effective in heroin-dependent patients; however, treatment retention was lower for buprenrophine.
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Addiction
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Buprenorphine maintenance can be divided into three phrases: induction, stabilization, and maintenance.

Induction

The goal of the induction is to find the patient's ideal daily dose of buprenorphine. The ideal daily dose minimizes both side effects and drug craving. For most opioid-dependent patients, the daily dose is 12 to 16 mg/day of the buprenorphine+ naloxone combination film or tablet. Induction usually takes 2 to 4 days to complete.

Stabilization

Transfer from Methadone Form

Description: 
This form provides a list of important considerations when determining whether a methadone patient is a candidate for transfer to buprenorphine treatment, including social, medical, and psychiatric history.

 

 Request Transfer from Methadone Maintenance to Office-Based Opioid Treatment 
Utilizing Buprenorphine 


Client Name: ______________________________
Date: ______________________________________
Admission Date: ___________________________
ID#: ________________________________________
DOB: _______________________________________

 

Transfer Criteria (please check the appropriate box and fill in as much information as possible):

[] On 30mg or less of Methadone.

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Description: 
Presently, methadone is the recommended treatment for opioid-dependent pregnant women, but is associated with neonatal abstinence syndrome (NAS). NAS is characterized by opioid withdrawal symptoms in the newborn, which often requires longer hospitalization and treatment. Buprenorphine, FDA-approved in 2002 for the treatment of opioid dependence in non-pregnant individuals, hasn't been extensively studied during pregnancy. Yet, a new study in the New England Journal of Medicine (NEJM) found that buprenorphine offers an alternative to methadone in the treatment of opioid-dependent pregnant women. The study compared buprenorphine to methadone in 131 mothers and their newborns at eight international sites.
Source: 
New England Journal of Medicine
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Day 1

Description: 
Induction for Patients Physically Dependent on Long-Acting Opioids

This dosing flow chart depicts clinical dosing guidelines for patients physically dependent on long-acting opioids such as methadone. Guidelines are provided for what to do if the patient's withdrawal symptoms continue or return, and establishing the daily dose if the symptoms are relieved.

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Day 1

Description: 
Dosing Flowchart of Buprenorphine Induction for Patients Dependent on Long-Acting Opioids

This dosing flow chart depicts clinical dosing guidelines for patients physically dependent on long-acting opioids such as methadone. Guidelines are provided for what to do if the patient's withdrawal symptoms continue or return, and establishing the daily dose if the symptoms are relieved.

© 2012, Clinical Tools, Inc.

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Days 2+

Description: 
Dosing Flowchart of Buprenorphine Induction for Patients Dependent on Short- or Long-Acting Opioids

This dosing flow chart depicts clinical guidelines for patients who are physically dependent on short- or long- acting opioids. Guidelines are provided for if the withdrawal symptoms are present since the last dose, if the withdrawal symptoms continue, if the withdrawal symptoms return, and establishing the daily dose.

© 2012, Clinical Tools, Inc.

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Description: 
This article provides guidance on the treatment of alcohol and drug abuse, and discusses various treatment plans.
Source: 
National Institute on Drug Abuse (NIDA)
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Description: 
The ASI Self-Report Form asks questions about the following topics: your background and employment, your health and family relationships, your legal situation, and your drug and alcohol use.
Source: 
Center for Health Care Evaluation (CHCE)
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