BUPRENORPHINE VS. METHADONE FOR HEROIN ADDICTION

Researchers in Pisa, Italy recently published findings from a study of heroin addicts treated with either buprenorphine or methadone. The study was a follow-up to earlier studies by the same group; one that examined the personality characteristics of heroin addicts, and a second that measured the impact of agonist treatment on psychiatric symptomatology and the quality of life of heroin addicts. The recent third study, published in the Annals of General Psychiatry, divided heroin addicts according to personality traits, and then examined whether these personality traits predicted success with one agonist treatment over another (i.e. methadone vs. buprenorphine).
‘Agonist treatment’ is used in the Italian studies to refer to maintenance with methadone or with buprenorphine—even though buprenorphine is technically a ‘partial agonist’ rather than an ‘agonist.’ Personality characteristics were defined using an instrument called the SCL-90 (Symptom CheckList-90).

In the first study, researchers found that the 1000 or so addicts could be divided into five subgroups, according to clusters of symptoms. One subgroup was characterized by depressive symptoms. The second was characterized by somatic symptoms, i.e. focus on physical symptoms and complaints. The third group was characterized by ‘interpersonal sensitivity’ and symptoms of psychosis—such as delusions. The fourth group had significant panic or anxiety symptoms, and the final group had symptoms related to violence toward self or others, including suicidality and self-mutilation.
The second study followed over 200 patients over the course of a year of maintenance treatment– about half with methadone and about half with buprenorphine—and measured the intensity of psychiatric symptoms collected on the SCL-90 over time. Not surprisingly, symptoms improved for both groups over the treatment period. The findings are consistent with my own observations while treating over 400 patients using buprenorphine over a period of 6 years; that people treated with buprenorphine get better in all spheres of life—far beyond simply avoiding opioids.

I’ve written about this issue in multiple posts around the web; I have come to see the ‘character defects’ associated with active opioid dependence to be dynamic, and related to the intense obsession for opioids rather than to static aspects of personality. In the words of Recovery, I initially worried that buprenorphine treatment would result in a ‘dry drunk’ for opioid addicts, where opioid use stopped but character defects remained. But that is not what I found. And the second study by the Pisa researchers showed, as well, that psychiatric symptoms decreased during time on buprenorphine or methadone, as addicts spent time away from the craving for opioids.
The third study observed how people with psychiatric symptoms from the five subgroups responded to treatment with methadone, vs. their response to buprenorphine.

For three of the subgroups, the choice of agonist treatment did not significantly impact the treatment response rate. But for two subgroups, the choice of methadone or buprenorphine had significant impact. Specifically, addicts from the interpersonal sensitivity subgroup had higher completion rates on methadone than they did on buprenorphine, and those from the violence/suicide group did better on buprenorphine than on methadone.

Studies that divide personality into subgroups require distinctions between character traits that are sometimes more arbitrary than ‘natural.’ But for people who are torn between treating their opioid dependence with one maintenance agent or another, the results from Pisa suggest that heroin addicts who struggle with interpersonal sensitivity and anxiety may do better on methadone maintenance than on buprenorphine. And the opposite may be the case for those who struggle with aggression or suicidal thoughts; buprenorphine may be the better approach in those cases.

These are general observations, but they are important steps toward finding the best treatment approaches for those suffering from opioid dependence—an illness that continues to ravage much of the country.


Original link

http://blogs.psychcentral.com/epidemic-addiction/2011/06/buprenorphine-vs-methadone-for-heroin-addiction/