Methadone-Buprenorphine Transfers Using Low Dosing of Buprenorphine: An Open-Label, Nonrandomized Clinical Trial

Chris Tremonti; James Blogg; Nazila Jamshidi; Ricky Harjanto; Nicholas Miles; Charlotte Ismay; Robert Page; Llew Mills; Nicholas Buckley; Varan Perananthan; Nicholas Lintzeris; Paul Haber

doi:10.1097/ADM.0000000000001379

Methadone-Buprenorphine Transfers Using Low Dosing of Buprenorphine: An Open-Label, Nonrandomized Clinical Trial

J Addict Med. 2024 Dec 3. doi: 10.1097/ADM.0000000000001379. Online ahead of print.

Authors

Chris Tremonti¹, James Blogg, Nazila Jamshidi, Ricky Harjanto, Nicholas Miles, Charlotte Ismay, Robert Page, Llew Mills, Nicholas Buckley, Varan Perananthan, Nicholas Lintzeris, Paul Haber

Affiliation

¹ From the Alcohol and Drug Services St Vincent's Hospital, Sydney, Australia (CT); Sydney Local Health District Drug Health Services, Sydney, Australia (CT, JB, NJ, PH); University of Sydney, Sydney, Australia (CT); Drug Health Services, South Western Sydney Local Health District, Sydney, Australia (RH); Northern Sydney Local Health District, Drug & Alcohol Service, Sydney, Australia (NM); Drug and Alcohol Clinical Services, Hunter New England Local Health District, Newcastle, Australia (CI); South Eastern Sydney Local Health District, Drug and Alcohol Services, Sydney, Australia (RP, NL); UNSW Sydney (RP); Division Addiction Medicine, Central Clinical School; South Eastern Sydney Local Health District, Drug and Alcohol Services, NSW Drug and Alcohol Clinical Research and Improvement Network (DACRIN), Sydney, Australia (LM, NL, PH); NSW Poisons Centre, Sydney, Australia (NB); Edith Collins Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia (NB, VP, PH); Clinical Pharmacology and Toxicology Research Group, Biomedical Informatics & Digital Health, Sydney Medical School, University of Sydney, Sydney, Australia (NB, VP); NSW Health Speciality of Addiction Medicine, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia (NL); and Faculty of Health and Medicine University of Sydney, Sydney, Australia (NJ, PH).

PMID: 39625175
DOI: 10.1097/ADM.0000000000001379

Abstract

Aims: To compare a low-dosing protocol to standard practice for methadone-buprenorphine transfers.

Methods: We undertook a nonrandomized open-label clinical trial across 8 sites from NSW, Australia. Participants prescribed methadone wishing to transfer to buprenorphine could either choose or be randomized to a low-dose transfer or standard care transfer as per NSW health guidelines. The low-dose protocol started at 0.2 mg BD and increased to 16 mg on day 6, with flexible dosing thereafter. The primary outcome was continuation of buprenorphine 1 week post-transfer. Binary logistic regression was used to access the primary outcome with demographic differences between the groups included as covariates.

Results: There were 117 participants who commenced the study, 101 in the low-dose arm and 16 in standard care. Mean methadone dose was 82 mg in the low-dose arm and 46 mg in standard care. The primary outcome was met by 81 participants in the low-dose arm (80%) and 13 participants in standard care (81%). There was no significant between-arm difference in the odds of the primary outcome (OR = 2.22; 95% CI: 0.45-10.91; P = 0.327). Four participants (4%) in the low-dose arm experienced precipitated withdrawal against 1 (6%) in standard care. Higher methadone dose decreased the odds of successful transfer by 20% (OR = 0.8 per 10 mg methadone; 95% CI: 0.7-0.99; P = 0.04). Withdrawal scores between the 2 arms were similar.

Conclusions: We were unable to detect a difference between low dosing and standard care for methadone to buprenorphine transfers. Increasing methadone dose was a predictor of success; setting (ambulatory or inpatient) was not.