But there are key differences between buprenorphine and methadone. Buprenorphine is a partial agonist; methadone, like heroin, is a full agonist. It is by their actions on opioid receptors that opioids achieve their analgesic (pain-killing) as well as their addictive effects.
Full Answer
What is the difference between methadone and buprenorphine?
Methadone is a full opioid agonist and overdose-related deaths (mostly mediated though respiratory depression) are a significant problem.[8,9] Buprenorphine, a partial opioid agonist, has become an increasingly popular choice in clinical practice in recent years in a number of developed countries, such as UK, France, USA, and Australia.
Is Buprenorphine a useful addition to the armory of drug therapy?
However, buprenorphine is a useful addition to the armory of pharmacotherapies available to substance use clinicians. This viewpoint is supported by the NICE and guidelines in India.[30,26]
Can buprenorphine overtake methadone in the UK?
Despite the obvious benefits conferred by the ceiling effect, buprenorphine prescriptions have failed to overtake methadone in the UK. Therefore, it seems that other issues are more important.
What is the mode of action of buprenorphine?
Mode of action of buprenorphine. Due to its unique pharmacologic profile, buprenorphine has, in principle, a number of advantages over methadone for use as an opioid replacement therapy. For example, it has low intrinsic activity at mμ receptors. This means that buprenorphine is not as potent as a full mμ agonist, like methadone,...
Can opioid replacement cause death?
All opioid replacement therapies considered here can potentially cause death but continued heroin use is associated with high morbidity. For example, Caplehorn and Drummer found that methadone maintenance saved two lives for every one lost in a year.[8] .
Is heroin a synthetic drug?
Opiate drugs, such as heroin (diamorphine), are natural derivates from opium, whereas opioids, such as methadone and buprenorphine, are synthetic derivates of opiates. There are a number of opioid receptor subtypes in the central nervous system and the effect of their activation is shown in Table 1.
Does buprenorphine cause respiratory depression?
Buprenorphine causes less respiratory depression than methadone due to its ceiling effect and, thus, has lower overdose potential.[16] . In a recent pooled analysis of RCTs of opioid maintenance therapy buprenorphine showed no significant differences in serious adverse events compared with methadone.[15] .
Is buprenorphine a partial agonist?
Open in a separate window. As a partial agonist, buprenorphine has a “ceiling effect,” that is, after a certain point taking more will not increase any of the effects of the drug.
Is buprenorphine a substitute for methadone?
Open in a separate window. Mode of action of buprenorphine. Due to its unique pharmacologic profile, buprenorphine has, in principle, a number of advantages over methadone for use as an opioid replacement therapy. For example, it has low intrinsic activity at mμ receptors.
Is methadone a first line drug?
The National Institute of Health and Clinical Excellence (NICE) in the UK recommends both buprenorphine and methadone as a first line treatment for both medically assisted withdrawal from heroin or other opiates or opioids and for maintenance purposes, with due consideration given to service user preference.
Is heroin a social problem?
Abstract. Heroin dependence is a major health and social problem associated with increased morbidity and mortality that adversely affects social circumstances, productivity, and healthcare and law enforcement costs. In the UK and many other Western countries, both methadone and buprenorphine are recommended by the relevant agencies ...
Methadone
Methadone is the medication with the longest history of use for opioid use disorder treatment, having been used since 1947. A large number of studies (some of which are summarized in the graph below) support methadone's effectiveness at reducing opioid use.
Buprenorphine
Buprenorphine, which was first approved in 2002, is currently available in two forms: alone (Probuphine ®, Sublocade™, Bunavail ®) and in combination with the opioid receptor antagonist naloxone (Suboxone ®, Zubsolv ® ).
Methadone and Buprenorphine Compared
Methadone and buprenorphine are equally effective at reducing opioid use. A comprehensive Cochrane review comparing buprenorphine, methadone, and placebo found no differences in opioid-positive drug tests or self-reported heroin use when treating with methadone or buprenorphine at medium-to-high doses. 13
Naltrexone
Naltrexone was initially approved for the treatment of opioid use disorder in a daily pill form. It does not produce tolerance or withdrawal. Poor treatment adherence has primarily limited the real-world effectiveness of this formulation.
Buprenorphine and Naltrexone Compared
A NIDA study showed that once treatment is initiated, a buprenorphine/naloxone combination and an extended release naltrexone formulation are similarly effective in treating opioid use disorder. Because naltrexone requires full detoxification, initiating treatment among active opioid users was more difficult with this medication.