Methadone and Buprenorphine Patients Survived at Equal Rates

A study showing a lower death rate with one opioid medication could appear like a reason to favor it for addiction treatment. Clinical commentary published by Medscape Medical News makes a different case.

The commentary argues that the mortality difference between methadone and buprenorphine naloxone is minuscule and both options should remain available.

It should be noted that this is commentary and reporting on a study that currently exists. It isn’t a new research finding.

What the Study Examined

The research followed 5,882 people in Ontario, Canada who started opioid agonist treatment between January 2017 and December 2023. Each person had visited an emergency department for an opioid overdose during the previous year.

Participants had a mean age of 35.8 years and 32.1 percent were women. They also have to have gone at least seven days without using either medication before starting treatment.

Within one year 5.6 percent of people who started methadone died compared with 7.1 percent of those who started buprenorphine-naloxone.

Why Clinicians Urge Caution

Robert Kleinman, the study’s lead author and a scientist at the Centre for Addiction and Mental Health in Toronto, told Medscape News Canada that the study is limited, because it was observational.

He expressed that the findings need to be replicated in other jurisdictions. His takeaway for clinicians was straightforward. Methadone and buprenorphine-naloxone both treat opioid use disorder and both should remain available after an overdose.

The researchers also acknowledged that unmeasured factors could have affected the results. They called for epidemiologic studies in other settings to see whether the findings hold up.

The Overdose Data Tells a Different Story

Death wasn’t the only outcome researchers tracked. Across the matched cohort, 1,544 people, or 26.2%, experienced an opioid overdose during the year of follow-up. That included fatal and nonfatal overdoses.

The rate was 27.1 percent in the methadone group. In the buprenorphine-naloxone group, 25.4 percent. Researchers found no significant difference.

People in both groups also stayed on treatment for short periods. Treatment duration was especially brief among those who started buprenorphine-naloxone.

There was another important finding. Mortality didn’t differ significantly during periods when participants were actually taking opioid agonist medication.

That detail changes how the headline numbers look. When researchers compare people during active treatment, the measurable survival difference disappears.

How the Medications Differ

Methadone is a full opioid agonist. It fully activates opioid receptors, which helps ease withdrawal and reduce cravings. Treatment is dispensed through federally regulated opioid treatment programs and often involves daily supervised dosing when treatment begins.

Buprenorphine-naloxone combines a partial opioid agonist with naloxone. The medication has a ceiling effect on respiratory depression which gives it a wider safety margin in an overdose. Patients can also receive prescriptions through office based care and take the medication at home.

Both medications can reduce opioid withdrawal symptoms and cravings. They can also be started during or immediately after supervised withdrawal management.

Neither medication is a short detox that ends after a set number of days. Both are maintenance treatments. Stopping either one can leave you with a higher risk of overdose.

What This Means When Choosing Medical Detox

If you’re comparing detox centers or planning a medically supervised medication start, the key question isn’t which medication has the better number in a mortality table. It’s which treatment setup you can keep using after the first month.

Ask the program how it moves patients from supervised withdrawal into ongoing medication. That handoff can be a vulnerable point in treatment.

You should also ask whether the facility can start methadone itself or needs to refer you elsewhere. Find out whether it can arrange a buprenorphine prescriber before you leave.

Daily dosing may not fit your life if you have work, childcare or transportation issues. Tell the intake staff that upfront rather than waiting until missed appointments become a problem.

Finding Medical Detox

Detox.com’s directory lists medically supervised detox programs and detox centers. You’re able to filter by location, substance treated, level of care and insurance accepted.

You can also find programs that begin medication assisted treatment before discharge. Call 800-996-6135Sponsored to learn more about treatment options available to you.