Transitioning Stable Methadone Maintenance Patients to Buprenorphine Maintenance

OBJECTIVES: Little data exists on psychosocially stable patients maintained long term on methadone maintenance treatment who attempt to transition their maintenance treatment to buprenorphine. The aims of this study were (1) to determine whether there is a correlation between baseline methadone maintenance dose and final buprenorphine maintenance dose, (2) to investigate subjective and objective outcomes over time in psychosocially stable opioid-dependent patients who transitioned their long-term maintenance treatment from methadone to buprenorphine. METHODS: In this retrospective study, 104 such patients on dosages of methadone 5 to 80 mg/d were offered the opportunity to convert their maintenance treatment to buprenorphine, of which 25 accepted. RESULTS: All patients (n = 25, 100%) who readily attempted transition to buprenorphine succeeded. A low-moderate association was found between patients' pretransfer methadone dose and posttransfer buprenorphine dose (Spearman correlation coefficient ρ = 0.46, P = 0.02). At a mean 30.3 months duration (SD 16.5), 22 patients (88%) remained on buprenorphine maintenance, 1 patient (4%) tapered off buprenorphine under clinician supervision, 1 patient (4%) died of hepatitis C, and 1 patient (4%) relapsed to cocaine and was lost to follow-up. CONCLUSIONS: The results demonstrate a low to moderate association between methadone and buprenorphine maintenance doses, and that buprenorphine is a viable maintenance treatment for opioid dependence for psychosocially stable patients on long-term methadone maintenance dosages up to 80 mg/d.