What Differs between Patients under Methadone and under Buprenorphine for Opioid Use Disorder (OUD) in Daily Clinical Practice in France? A Short Report.

Morgane Guillou-Landreat,Juliette Leboucher,Caroline Victorri-Vigneau,Marie Grall-Bronnec,Antoine Dany,Edouard Laforgue,Gaëlle Challet-Bouju,Jean Benoit Hardouin

doi:10.3390/ijerph18041425

Abstract

(1) Background: Opioid use disorder (OUD) is a complex condition that can require long-term treatment. Pharmacological therapy for OUD involves treatment with opioid agonists (OMT) tailored to individual profiles. The aim of our study in daily clinical practice was to compare the profiles of patients treated with methadone (MTD) and those using buprenorphine (BHD or BHD-naloxone-NX). (2) Methods: A cross-sectional multicentre study explored the psychological, somatic and social profiles of patients with Opioid Use Disorder (OUD) following Opioid Maintenance Treatment (BHD, BHD/NX, or MTD). Descriptive and comparative analyses were performed (3) Results: 257 patients were included, a majority were men using heroin. 68% (178) were on MTD, 32% (79) were on BHD. Patients with MTD were significantly more likely to report socio-affective damage, and more likely to be younger and not to report oral or sublingual use as the main route for heroin or non-medical opioids (4) Conclusions: In daily clinical practice, regarding OUD damage, only socio-affective damage was significantly more prevalent among patients on MTD than among those on BHD in the multivariate model. Age and route of administration also differed, and our results could raise the issue of the type of OMT prescribed in case of non-medical use of prescribed opioids. These hypothesis should be confirmed in larger studies.

Highlights

Opioid use disorder (OUD) is characterized by the repeated use of opioids with harmful consequences [1], and is associated with increased early morbidity and mortality [2].Treatment for OUD combines psychosocial interventions and pharmacotherapy, including Opioid Maintenance Treatment (OMT): Methadone (MTD) and Buprenorphine (BHD) or Buprenorphine-naloxone (BHD/NX)
Our results raise the issue of the non-medical use of prescribed opioids and the indications and type of OMT to implement in this case
In pragmatic daily clinical practice in this study, BHD seemed to be more frequently prescribed in this context

Summary

Introduction

Treatment for OUD combines psychosocial interventions and pharmacotherapy, including Opioid Maintenance Treatment (OMT): Methadone (MTD) and Buprenorphine (BHD) or Buprenorphine-naloxone (BHD/NX). The main goals of OUD treatment focus on harm reduction and improvement of psycho-social and health outcomes [3]. The pharmacological characteristics differ: MTD is a full mu agonist and BHD is a partial mu agonist. They are efficacious and have proved to be efficient in terms of public health [3,4,5]. In France, BHD can be prescribed by any physician, while MTD, listed as a narcotic, is less accessible. After a period of stabilization, follow-up and prescription can be carried out by any physician [3,4,5].

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