Home > ASME Articles > What is the Best Dosing Strategy for Buprenorphine or Methadone to Prevent Relapse?
Opioid use disorder (OUD) continues to be a leading cause of death and illness in the U.S. Two of the most effective treatments for OUD are buprenorphine-naloxone (BUP-NX) and methadone.
Although providers know that having a “high enough” dose of buprenorphine or methadone is important, less is known about what that dose might be or how it should be attained.
Key points:
Researchers for this study used data from three NIDA Clinical Trials Network (CTN) studies about opioid use disorder treatment: CTN-0027, CTN-0030, and CTN-0051, to examine the risk of relapse under 4 different dosing strategies (separately for BUP-NX and methadone):
Examining the data, researchers found that for BUP-NX, increasing dose following the hybrid strategy resulted in the lowest risk of relapse.
For methadone, holding the dose constant resulted in the worst outcomes and the other 3 strategies (1-3 above) performed equally well. For example, the hybrid strategy reduced week 12 relapse risk by 13% for BUP-NX and by 20% for methadone, as compared to holding the dose constant.
Conclusions: In this study, patients taking BUP-NX for OUD had the lowest risk of relapse when their dose was increased weekly until a target dose was reached, and then increased again in the future in response to a recurrence of opioid use. For patients on methadone, the hybrid approach or either approach alone worked equally well and much better than holding the dose constant after 2 weeks of treatment. There may not be a single best dosing strategy for all patients, however these findings support a clinical recommendation that doses be targeted toward a minimum threshold and, in the case of BUP-NX, be raised again any time patients continue using opioids.