Methadone Versus Buprenorphine/Naloxone: Treatment Outcome Differences Among Individuals Receiving Medications for Opioid Use Disorders in Rural Treatment Settings—A 1-Year Retrospective Cohort Study

Abstract

Background

Medication for opioid use disorder (MOUD) is the gold standard of treatment for opioid use disorder (OUD). Methadone and buprenorphine have shown to be the most effective MOUD, yet little is known about the compared efficacy when treating OUD in community-based rural treatment settings. This study aims to explore treatment outcome differences among patients initiating methadone or buprenorphine/naloxone in community-based rural treatment programs.

Methods

Data for this 1-year retrospective cohort study were extracted from electronic medical records of 561 individuals initiating treatment between January 2019 and December 2019 at four MOUD clinics located in rural Oregon. Between-group comparisons were conducted using chi-square for dichotomous variables and ANOVA for continuous variables. Kaplan Meier and generalized estimating equations were used to determine treatment retention and opioid use over time.

Results

Of the 561 patients, 74.5% were dispensed methadone while 25.5% were prescribed buprenorphine/naloxone. Those dispensed methadone were more likely to be unemployed (57.7% vs. 44.8%, p = 0.01) and diagnosed with severe OUD (93.5% vs. 83.9%, p = 0.04). There were no significant group differences on other treatment intake demographics nor opioid use or treatment retention over a 12-month period. Clinic site was a significant predictor of proportion of negative urine tests.

Conclusion

Both methadone and buprenorphine/naloxone performed comparably well in reducing opioid use and retaining patients in treatment. In comparison to medication type, clinical site and time in treatment had a larger impact on participant outcomes. These findings suggest that the use of both methadone and buprenorphine/naloxone should be encouraged in the context of rural MOUD treatment programs.