A Comparison of Medication-Assisted Treatment Options for Opioid Addiction: A Review of the Literature.
Amanda Spayde-Baker, Jennifer Patek
PMID 34224485WHAT IT FOUND
Buprenorphine and methadone can reduce opioid use or support retention, while extended-release naltrexone has mixed evidence.
Methadone may retain patients best, buprenorphine can start in office or home, and naltrexone requires 7 to 14 days opioid-free before induction.
Key findings
01Buprenorphine treatment was associated with a lower risk of overdose during active treatment than no treatment or naltrexone.
02Methadone doses greater than 80 to 100 mg per day and an average plasma concentration of 400 ng/ml were associated with longest treatment retention and decreased illicit opioid use.
03Extended-release naltrexone induction success was lower than buprenorphine or methadone, 41.7% versus 100%, in individuals not previously detoxified.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a review of other studies, not one new trial, so its strength depends on the included studies and it reports no single primary outcome. The naltrexone retention result came from a small study with 16 individuals with opioid use disorder, 27 with alcohol use disorder, and 8 with both, and the authors said larger replication is needed. The methadone versus buprenorphine adherence difference, 49.1% versus 40.8%, was not significant, p = .096, so it is not a clear advantage. Naltrexone induction was less successful than buprenorphine or methadone, 41.7% versus 100%, in patients not previously detoxified, which limits its use in some settings. Several included studies had design or sample limits, including nonrandomized observation, nonrepresentative regional samples, missing data, and confounding variables such as parole status. The review included one article with a C quality rating because of small sample size.
The easy way to misread this
Do not read the 100% retention rate as proof that extended-release naltrexone works for most patients. It came from a small study in a specific outpatient HIV clinic population, and induction success was lower than buprenorphine or methadone, 41.7% versus 100%, when patients were not previously detoxified.