The focus of
drug policy in the UK has shifted markedly in the past 5 years to move beyond merely emphasising
drug abstinence towards maximising individuals' opportunities for recovery. The UK government continues to recognise the prescribing of
narcotic medications indicated for
opiate dependence as a key
element of these individuals' recovery journey. This article describes a small, naturalistic comparison of the efficacy of the two most commonly prescribed
opiate substitute medications in the UK--
methadone hydrochloride (
methadone oral
solution) and
Suboxone (
buprenorphine-naloxone sublingual
tablets)--for reducing current
heroin users' (n = 34) days of
heroin use, and preventing short-term abstainers (n = 37) from relapsing to regular
heroin use. All patients had been prescribed either
methadone or
Suboxone for maintenance for 6 months prior to intake. Results showed that when controlling for a number of patient-level covariates, both
methadone and
Suboxone significantly reduced current users' days of
heroin use between the 90 days prior to intake and at the 8-month follow-up, with
Suboxone yielding a significantly larger magnitude reduction in
heroin use days than
methadone.
Methadone and
Suboxone were highly and equally effective for preventing relapse to regular
heroin use, with all but 3 of 37 (91.9%) patients who were abstinent at intake reporting past 90-day point prevalence
heroin abstinence at the 8-month follow-up. Overall, prescribing
methadone or
Suboxone for eight continuous months was highly effective for initiating abstinence from
heroin use, and for converting short-term abstinence to long-term abstinence. However, the study design, which was based on a relatively small sample size and was not able randomise patients to medication and so could not control for the effects of potential prognostic factors inherent within each patient group, means that these conclusions can only be made tentatively. These positive but preliminary indications of the comparative efficacy of
methadone and
Suboxone for treating
opiate dependence now require replication in a well-powered, randomised controlled trial.