These differences remained even after adjusting for differences in patient and practice characteristics for those prescribed methadone or buprenorphine. Patients on buprenorphine also had lower rates of all-cause mortality during and immediately after treatment – which may be because patients who are older and have other physical and mental health complications may do better on buprenorphine than methadone. The study also confirmed that patients on buprenorphine do not stay in treatment for as long as patients on methadone. Since the benefits of treatment are greater the longer treatment lasts, this needs to be considered in relation to the choice of substitute drug. The researchers undertook a modelling exercise to see what impact treatment duration might have at a population level. They concluded that, overall, treatment using buprenorphine alone was unlikely to reduce the risk of drug related poisoning deaths because the treatment periods are shorter than for methadone.
“Despite the record number of patients in treatment, drug related deaths continue to rise. Our research provides evidence to support a change in the way treatment is delivered that could save lives. We now need trials in the UK on how we combine different opioid substitution treatments alongside other behaviour change interventions to retain people in treatment long enough to reduce the number of drug related deaths in the population.”
Professor John Macleod, joint lead author from the Centre for Academic Primary Care at the University of Bristol, said:
“Although this is a somewhat complicated picture, with lower rates of death for patients on buprenorphine offset at a population level by the shorter treatment durations, our findings clearly suggest that buprenorphine may be the safer treatment option. Because of the shorter treatment duration associated with its use, starting treatment with buprenorphine then giving patients the option to switch to methadone later could be the best approach.
“Internationally, there is no consensus about which medication to use. In the UK, the British Association for Psychopharmacology currently recommends methadone as the first-line treatment if there are no contraindications. We believe that future guidance should take these findings into account.”
Professor Matthew Hickman, from the NIHR Health Protection Research Unit and Population Health Sciences at University of Bristol, and joint lead author of the study, said:
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