Transfer from high dose methadone to buprenorphine on a specialist in-patient unit – a case series

First published: 10/05/2019 | Last updated: May 20th, 2019

Aims: Buprenorphine is the only licensed alternative to methadone in the UK for opioid replacement therapy. It carries less risk of respiratory depression and is safer in overdose. As it is a partial agonist, the withdrawal syndrome is often milder. Some patients are intolerant of methadone, find it stigmatizing or may be required to change due to drug interactions or prolonged QTc interval. Most current guidance advises a reduction in methadone to 30mg before transfer due to the risk of precipitated withdrawal, running a high risk of destabilization.

Methods: Patients on methadone doses up to 120mg / day were admitted to the Ritson Clinic (specialist in-patient addictions unit) through their community addiction key workers. All gave written consent to be included in a prospective case series. Information recorded included diagnoses, comorbidity, use of alcohol and other drugs, length of time from stopping methadone to starting buprenorphine, COWS scores, dose on discharge, lofexidine required, length of stay and perceived outcomes.

Results: 15 patients were admitted from May 2012 to April 2013, and all successfully transferred to buprenorphine. Average time from stopping methadone to starting buprenorphine was 61.5 hours, and average length of stay was 6.5 days. None were considered to have precipitated withdrawal, and most perceived outcome as good or reasonable.

Conclusions: Complex patients on higher doses of methadone can be transferred to buprenorphine in the in-patient setting. Timings and doses are highly variable. This series may help to inform further guidance in high dose transfers, both as in and out-patients.

No conflicts of interest declared.

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Dr Rebecca Lawrence