Buprenorphine versus methadone maintenance treatment in an ambulant setting: a health-related quality of life assessment

FRANÇAIS :
Les symptômes physiques et la consommation de drogues ont été mesurés chez 53 patients admis en traitement de maintenance à la buprénorphine ou à la méthadone. Sur un suivi de 24 semaines aucune différence significative n'est observée entre les deux groupes par rapport à la qualité de vie. Les patients en traitement buprénorphine consomment moins d'héroïne et de cocaïne et leurs symptômes de sevrage sont également moins prononcés (crampe d'estomac, fatique, épuisement, sensation de froid). La conclusion suggère que la buprénorphine ait un potentiel de réduction des méfaits engendrés par la consommation d'héroïne.
ENGLISH :
Background: To compare the effects on quality of life (QOL) of oral methadone with sublingual buprenorphine. Methods: We performed an open-label, non-randomized, two-site (rnethadone- buprenorphine) study. During 6 months we assessed the quality of life status of 53 opioid-dependent patients admitted to a methadone or buprenorphine maintenance programme using the German version (Berlin Quality of Life Profile) of the Lancashire Quality of Life Profile. Physical symptoms were measured using the Opioid Withdrawal Scale. Five hundred and thirty urine screening tests were carried out randomly to detect additional consumption. Results: Sixty-seven opioid-dependent subjects (38 on methadone and 29 on buprenorphine) were enrolled in the study, and 53 completed it (30 subjects treated with buprenorphine and 23 subjects with racemic methadone). The subjects were comparable on all baseline measures. At the first follow-up (week 8), the buprenorphine-maintained group showed significantly less additional consumption of opioids (P=0.013) compared with the methadone group. Patients retained in the buprenorphine or methadone programme (week 24) showed no significant differences in all quality of life scores. At the end of the study period, the buprenorphine-maintained group showed significantly less additional consumption of opioids (P=0.001) and cocaine (P=0.018) compared with the methadone group. The outcome measures for withdrawal symptoms after 24 weeks of treatment with buprenorphine showed slight advantages in stomach cramps, fatigue or tiredness, feelings of coldness and heart pounding. Conclusions: These results suggest that buprenorphine treatment is as effective as methadone regarding effects on quality of life and withdrawal symptoms. Buprenorphine has the potential to reduce the harm caused by drug abuse. Further research is needed to determine if buprenorphine is more effective than methadone in particular subgroups of patients. (Author' s abstract)