Buprenorphine and methadone appear equally effective in achieving abstinence from opioids, a prison-based study has found.

A total of 289 newly admitted prisoners, with proven opioid use and an expressed wish to detoxify, were recruited from three prison healthcare departments to a pragmatic, open-label, randomised controlled trial. Recruits were allocated at random to either sublingual buprenorphine or oral methadone treatment. Prescribing regimens were at the discretion of the prescribing doctor, but focused on a reducing dose programme lasting not more than 20 days.

The primary outcome measure was abstinence from illicit opioids at eight days post-detoxification, with secondary outcomes abstinence at one, three and six months post-detoxification.

Abstinence was ascertained in 73.7% of participants at eight days post-detoxification (52.6% by urine toxicology; 15.2% by self-reporting and 5.9% from clinical notes).

The authors found no significant difference in the odds of achieving abstinence between the methadone and buprenorphine arms of the study at eight days, one month and three months post-detoxification.

The respective odds ratios (OR) were: OR 1.69 (95% CI:0.81-3.51, P = 0.163); OR 0.38 (95% CI:0.13-1.10, P = 0.074); OR 1.50 (95% CI:0.37-6.04, P = 0.571). There were insufficient data to undertake statistical analysis at six months.

None of the variables relating to drug use prior to participating in the trial (such as previous success at achieving abstinence, or smoking or injecting use) was associated with a better or worse rate of achieving abstinence.

The development of a ‘recovery movement’ within drug using communities and treatment services has highlighted the need to maximise opportunities for those dependent on opioids to achieve and maintain abstinence from their drug of dependence. Around 75,000 drug users enter prison every year in the UK, many of whom use opioid and other class A drugs.

Though methadone and buprenorphine are recommended as first-line agents in opioid detoxification, there has been no empirical evidence to support which is the medication of choice.

The paper concludes that methadone and buprenorphine are equally clinically effective in helping opioid dependent prisoners to achieve abstinence. ‘Patients should not be discouraged from undertaking detoxification purely on current or past drug history and treatment success,’ the researchers say.

The authors also add that in areas where buprenorphine diversion is a problem, methadone should be offered as the first-line agent.

Dr Jez Thompson