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.