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Published VersionCC BY-NC-ND V4.0, Open Access
Journal article
Transferring Patients from Methadone to Buprenorphine: The Feasibility and Evaluation of Practice Guidelines
Journal of Addiction Medicine, Vol.12(3), pp.234-240
2018
PMID: 29509558
Abstract
Introduction and Aims:
Transfer from methadone to buprenorphine is problematic for many opioid-dependent patients, with limited documented evidence or practical clinical guidance, particularly for the range of methadone doses routinely prescribed for most patients (>50 mg). This study aimed to implement and evaluate recent national Australian guidelines for transferring patients from methadone to buprenorphine.
Design and Methods:
A multisite prospective cohort study. Participants were patients who transferred from methadone to buprenorphine-naloxone at 1 of 4 specialist addiction centers in Australia and New Zealand. Clinicians were trained in the guidelines, and medical records were reviewed to examine process (eg, transfer setting, doses, and guideline adherence) and safety (precipitated withdrawal) measures. Participants completed research interviews before and after transfer—assessing changes in substance use, health outcomes, and side effects.
Results:
In all, 33 participants underwent transfer, 9 from low methadone doses (<30 mg), 9 from medium doses (30–50 mg), and 15 from high doses (>50 mg). The majority of high-dose transfers occurred in inpatient settings. There was reasonable guideline adherence, and no complications identified in the low and medium-dose transfers. Three high-dose transfers (20%) experienced precipitated withdrawal, and 7/33 participants (21%) returned to methadone within 1 week of attempted transfer.
Discussions and Conclusions:
Transfer is feasible in outpatient settings for those transferring from methadone doses below 50 mg; however, inpatient settings and specialist supervision is recommended for higher-dose transfers. The Australian clinical guidelines appear safe and feasible, although further research is required to optimize high-dose transfer procedures.
Details
- Title
- Transferring Patients from Methadone to Buprenorphine: The Feasibility and Evaluation of Practice Guidelines
- Authors
- Nicholas Lintzeris (Corresponding Author) - South Eastern Sydney Local Health DistrictLauren A. Monds - South Eastern Sydney Local Health DistrictConsuelo Rivas - The University of SydneyStefanie Leung - The University of SydneyAdrian Dunlop - Hunter New England Local Health DistrictDavid Newcombe - University of AucklandCarina Walters - University of AucklandSusanna Galea - Waitemata District Health BoardNancy White - The University of AdelaideMark Montebello - South Eastern Sydney Local Health DistrictApo Demirkol - Hunter New England Local Health DistrictRobert Ali - Hunter New England Local Health DistrictNicola Swanson - The University of Adelaide
- Publication details
- Journal of Addiction Medicine, Vol.12(3), pp.234-240
- Publisher
- Lippincott Williams & Wilkins
- Date published
- 2018
- DOI
- 10.1097/ADM.0000000000000396
- ISSN
- 1935-3227; 1932-0620
- PMID
- 29509558
- Copyright note
- This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
- Grant note
- The project was supported with an Untied Educational Grant from Indivior, the manufacturers of Suboxone.
- Organisation Unit
- School of Health - Psychology
- Language
- English
- Record Identifier
- 991199350002621
- Output Type
- Journal article
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