Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
6802524 | Journal of Substance Abuse Treatment | 2015 | 4 Pages |
Abstract
The product license of buprenorphine/naloxone for opioid substitution therapy indicates reducing methadone concentrations to 30Â mg or less per day for a minimum of 1Â week before transferring patients to buprenorphine and no sooner than 24Â hours after the last methadone dose, because of the risk of precipitated withdrawal and a corresponding high risk of relapse to opioid use. There are few studies describing high-dose methadone transfers. This retrospective case review assessed the feasibility of transferring patients on methadone doses above 30Â mg/day to buprenorphine or buprenorphine/naloxone in the inpatient setting. Six of seven patients on 60-120Â mg/day of methadone successfully completed the transfer, and four cases tested negative for opiates at long-term follow-up (6-15 months). This suggests that methadone transfer to buprenorphine can be performed rapidly without the need to taper methadone doses in patients indicated for a therapeutic switch. This small study is hypothesis-generating; larger, well-designed trials are needed to define a protocol that can be used routinely to improve and widen transfers to buprenorphine when indicated.
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Authors
Rossana MB, BS, BSc (Hons), MSc, FRCPsych,