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Research Summary

Misuse and Diversion of Methadone and Buprenorphine Are Increasing, but Buprenorphine Appears to Have a Better Safety Profile

Buprenorphine is increasingly used for opioid agonist treatment and methadone for pain, raising concerns about diversion, misuse, and overdose. To assess the relative safety of both medica-tions investigators analyzed data from the Researched Abuse Diversion and Addiction-Related Surveillance (RADARS) system from 2003 to 2007. This system collects data from prescription-medication investigators and regulators, poison-control centers, and opioid-agonist treatment programs. Estimated rates of abuse, misuse, and diversion were calculated based on census data and pharmacy records.

  • Rates of misuse and diversion of both medications increased from 2003 to 2007 but were consistently higher for methadone.
  • Seventy-three percent of methadone-diversion cases were of the tablet form used for pain treatment as opposed to the liquid form used for opioid agonist treatment.
  • Poison-control centers received many more calls for methadone (7746) than for buprenorphine (1117). Almost half of the methadone calls were for major life-threatening events (3500 calls versus 288 for buprenorphine). They also received reports of 140 deaths associated with methadone versus 5 associated with buprenorphine.

Comments:

In this study, even when taking prescribing rates into account, methadone was associated with higher rates of diversion, misuse, and poisoning than buprenorphine. Although the comparison was primarily between buprenorphine prescribed for addiction and methadone prescribed for pain, these results reinforce concerns about the use of methadone for pain and provide some reassurance regarding the risks associated with diversion and misuse of buprenorphine. Darius A. Rastegar, MD

Reference:

Dasgupta N, Bailey EJ, Cicero T, et al. Postmarketing surveillance of methadone and buprenorphine in the United States. Pain Med. 2010;11(7):1078–1091.

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