Which Medication for Opioid Use Disorder Is Superior for Treatment Retention and Adherence: Buprenorphine or Methadone?

Buprenorphine and methadone can be life-saving medications for opioid use disorder (MOUDs). Researchers conducted a systemic review and meta-analysis of randomized controlled trials (RCTs) and observational studies published through July 2022 that compared sublingual buprenorphine with methadone for several OUD-related outcomes, including treatment retention and MOUD adherence.

• Researchers identified 32 RCTs and 69 observational studies directly comparing buprenorphine with methadone, and an additional 51 RCTs and 124 observational studies reporting on buprenorphine retention. Overall, 1,040,827 persons aged ≥18 years were included in analyses.

• Treatment retention at 3, 6, 12, and 24 months was statistically better among people who received methadone than those who received buprenorphine, although the absolute differences were modest (e.g., 6-month retention was 52 percent for buprenorphine versus 56 percent for methadone; 12-month retention was 43 percent for buprenorphine versus 47 percent for methadone).
• Adherence did not differ between patients receiving buprenorphine and those receiving methadone.

Comments: This study suggests that methadone may be slightly superior to sublingual buprenorphine for long-term OUD treatment retention, but this interpretation is limited by multiple factors, including differing methods and settings for provision of buprenorphine versus methadone—particularly in the US—and changes in illicit opioid potency in recent years. Importantly, less than half of persons receiving MOUD are retained in treatment at one year, underscoring the need for efforts to increase long-term treatment retention.

Carrie Mintz, MD

Reference: Degenhardt L, Clark B, Macpherson G, et al. Buprenorphine versus methadone for the treatment of opioid dependence: a systematic review and meta-analysis of randomised and observational studies. Lancet Psychiatry. 2023;10(6):386–402.