Buprenorphine-Based Regimens and Methadone for the Medical Management of Opioid Dependence: Selecting the Appropriate Drug for Treatment


  • Icro Maremmani MD,

    1. Vincent P. Dole Dual Diagnosis Unit, Department of Psychiatry, NPB, Santa Chiara University Hospital, University of Pisa, Italy
    2. AU-CNS, “From Science to Public Policy” Association, Pietrasanta, Lucca, Italy
    3. G. De Lisio, Institute of Behavioral Sciences, Pisa, Italy
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  • Gilberto Gerra MD

    1. Drug Prevention and Health Branch, Division for Operations, United Nations Office on Drugs and Crime, Vienna
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The views expressed herein are those of the authors and do not necessarily reflect the views of the United Nations. Address correspondence to Dr. Icro Maremmani, Department of Psychiatry, NPB, University of Pisa, Via Roma 67, Pisa 56100, Italy. E-mail: maremman@med.unipi.it.


Maintenance therapy with methadone or buprenorphine-based regimens reduces opioid dependence and associated harms. The perception that methadone is more effective than buprenorphine for maintenance treatment has been based on low buprenorphine doses and excessively slow induction regimens used in early buprenorphine trials. Subsequent studies show that the efficacy of buprenorphine sublingual tablet (Subutex®) or buprenorphine/naloxone sublingual tablet (Suboxone®) is equivalent to that of methadone when sufficient buprenorphine doses, rapid induction, and flexible dosing are used. Although methadone remains an essential maintenance therapy option, buprenorphine-based regimens increase access to care and provide safer, more appropriate treatment than methadone for some patients. (Am J Addict 2010;00:1–12)