https://journals.lww.com/journaladdictionmedicine/Fulltext/2018/06000/Transferring_Patients_From_Methadone_to.10.aspx

Lintzeris, Nicholas, PhD; Monds, Lauren, A., PhD; Rivas, Consuelo, RN; Leung, Stefanie, PhD; Dunlop, Adrian, PhD; Newcombe, David, PhD; Walters, Carina, MSc; Galea, Susanna, PhD; White, Nancy, PhD; Montebello, Mark, MBBS; Demirkol, Apo, PhD; Swanson, Nicola, RN; Ali, Robert, PhD

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, transfersetting, 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.

Comment;

I don’t like Methadone.  I see many patients who have been on extremely high doses of it–which makes withdrawal more difficult than ever.  Patients who do OK on lower doses of Methadone and even better on Buprenorphine–which they can come off of anytime they think they’re ready–which typically takes months to years, depending on how well they work a 12-Step program.  It’s nice to see that 50 mg can be used as a change-point from Methadone, I’ve always been a bit more cautious and used 30 mg, but will try my luck with 50 on patients who choose that route.  One problem with the study is that it states 7/33 wen back to methadone–which group or how many from which group reverted?

Dr. Raymond Oenbrink
Latest posts by Dr. Raymond Oenbrink (see all)