A couple of medication findings yesterday.

First, a meta-analysis of methadone and buprenorphine:

Low dose methadone is more likely to retain patients than low dose buprenorphine (RR= 0.67; 95% CI: 0.52 – 0.87). Medium dose buprenorphine does not retain more patients than low dose methadone, but may suppress heroin use better. There was no advantage for medium dose buprenorphine over medium dose methadone in retention (RR=0.79; 95% CI:0.64 – 0.99) and medium dose buprenorphine was inferior in suppression of heroin use.

Second, a report concluding that naltrexone and acomprosate enhance abstinence rates:

Alcohol-dependent individuals who consistently took prescribed medications to prevent withdrawal symptoms and craving had better treatment outcomes than those who didn’t take their medication, even among patients receiving behavioral counseling, researchers say.

HealthDay News reported June 20 that data from the National Institute on Alcohol Abuse and Alcoholism’s Combine study found that those patients who adhered to the medication regimen for naltrexone or acamprosate as well as taking part in medical-management (MM) or combined behavioral intervention (CBI) programs had more abstinent days and avoided heavy drinking more successfully than those who didn’t take their prescribed drugs as ordered.

“High medication adherents fared better than low medication adherents across all combinations of behavioral and pharmacological treatment conditions,” said researcher Allen Zweben of Columbia University.

The researchers also reported that CBI seemed to help even patients who took a placebo, but did not appear to affect relapse rates among naltrexone patients who didn’t take their medications.

I don’t know about you, but I don’t find this too persuasive. Isn’t it likely that medication adherence is an artifact of motivation? The carefully couched language suggests that the intent to treat analysis didn’t find that participants receiving medication did any better patients receiving placebo.

3 thoughts on “Medications

  1. I think that this story needs to have some more science in it. I do not see the same things that you do. I also find that suboxone (buprenorphine) does a great job with withdrawel and cravings.Thank you.Paul Bowman

  2. We’ll see when the actual study is published. As for as buprenorphine goes, my experience is that it’s a great tool for detox without the impairing mood altering effects or safety concerns that accompany methadone.

  3. I have taken both medications and did not find that either one altered my mood or impaired me in any way. I do agree that bupe is less likely to impair someone who does not have a large opiate tolerance or who is brand new to treatment, but I know quite a few methadone patients who are not impaired by their medication. The thing is, bupe is not a substitute for MMT–it is simply another much needed tool in the toolbox. Not everyone is suited for bupe as not everyone does well on methadone.

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