Research Snapshot: Suboxone offers safe alternative as take-home treatment for people with prescription opioid use disorder

What you need to know

Up until now, studies comparing suboxone and methadone were conducted under strict medical supervision to ensure the treatments were safe. Those receiving such treatment often find this approach restrictive, and many others end up not receiving it because the requirement to be under supervision limits ease of access. Suboxone simplifies and facilitates the use of opioid agonist treatment by allowing for home use. Researchers compared the two treatments and found that suboxone is flexible and safe and works as well as methadone in treating prescription opioid use disorder.

What is this research about?

Prescription and synthetic opioid use disorder and related harms are the third highest burden of disease linked to substance use after tobacco and alcohol. One strategy to tackle this problem is to treat opioid use disorder using opioid agonist therapy. While methadone has been the standard of care for years, suboxone (combination buprenorphine and naloxone) has been the preferred treatment in many countries and is now the recommended first-line treatment in Canadian guidelines.

Studies that compared suboxone and methadone have given patients their daily doses under strict medical observation. Many clients find it burdensome to have to go to a clinic every day, so they discontinue their treatment. Suboxone makes it simpler and easier to use opioid agonist treatment by allowing clients to take it at home.

Researchers with the Canadian Research Initiative in Substance Misuse conducted the OPTIMA trial (Optimizing Patient Centered-Care: A Pragmatic Randomized Control Trial Comparing Models of Care in the Management of Prescription Opioid Misuse) to evaluate the effectiveness of allowing clients with prescription opioid use disorder to take suboxone doses at home compared to standard methadone treatment. The researchers conducted the trial at seven sites in British Columbia, Alberta, Ontario and Quebec.

What did the researchers do? 

Participants were adult aged 18–64 seeking treatment for a diagnosis of opioid use disorder related to prescription-type opioids and requiring opioid agonist treatment. Half were selected at random to receive methadone under close supervision in a pharmacy, and the other half to receive suboxone, which could most often be taken at home.

Participants had follow-up visits with the research team every two weeks for 24 weeks. At these visits, they updated their demographic, substance use and other health related information and provided urine samples. These samples were tested for various illegal drugs (morphine, oxycodone, fentanyl, benzodiazepines, cocaine, amphetamine, methamphetamine, cannabis, buprenorphine, methadone, and tramadol).

What did the researchers find? 

Researchers are still working to piece all of the results from the trial together. Some of the findings to date include the following:

Limitations of the research

The researchers noted that they had excluded anyone who needed opioids for pain management and this exclusion should be taken into account when generalizing the results of this trial. In addition, the methadone dose used in the study was not at the higher range of its possible dosage, which could have decreased its effectiveness. However, their mean dosing of 82 mg was still higher than in some previous studies.

How can you use this research? 

This study provides evidence that opioid agonist treatment can be effective for people with prescription opioid use disorder. The study authors call for caution when interpreting OPTIMA’s results due to its low retention rates. In addition, the study’s Canadian-only focus makes it difficult to generalize the results to countries with a different type of healthcare system. They suggest there is an urgent need for innovative strategies to improve treatment outcomes and for better-adapted models of care. For example, integrated psychosocial interventions could be used to help individuals stay on treatment.

About the researchers

Didier Jutras-Aswad1,2, Bernard Le Foll3,4,5,6,7, Keith Ahamad8,9, Ron Lim10, Julie Bruneau1,11, Benedikt Fischer4,12,13,14, Jürgen Rehm4,5,15,16,17, Cameron Wild18, Evan Wood8,19, Suzanne Brissette1,11, Lea Gagnon1, Jill Fikowski8, Omar Ledjiar20, Benoit Masse20,21, M. Eugenia Socias8,19, for the OPTIMA Research Group within the Canadian Research Initiative in Substance Misuse.

  1. Research Centre, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada.
  2. Department of Psychiatry and Addictology, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.
  3. Department of Pharmacology and Toxicology and Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
  4. Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
  5. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
  6. Translational Addiction Research Laboratory, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.
  7. Acute Care Program, CAMH, Toronto, Ontario, Canada.
  8. British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada.
  9. Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
  10. Department of Family Medicine and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

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