Maintenance Treatment Relapse rates for stably maintained patients is as high as 82% within 1 year off of methadone Ball et al. The Effectiveness of Methadone Treatment. New York: Springer-Verlag; 1991

Taper or Maintenance Treatment Outcome Maintenance Taper Abstinence 53% 35% Days per week of opioid use 0.47 days 1.27 days Consecutive weeks of abstinence 5.2 weeks 2.7 weeks Trial completion 66% 11% 14 week study at a primary care site. 113 patients randomized to taper or maint on bup over 14 weeks. Taper started at week 6- patients received treatment for withdrawal, more counseling, and were offered naltrexone (only two picked this route). Outcomes: opioid use, treatment retention, reinitiation of bup. Fiellin DA et al. JAMA Intern Med 2014;174:1947-1954

Opioid Use after Discontinuation Approx Relapse Rates 50-80% 90% 80% 65% 55% Study Sample Size Maint Period Mean Dose Abstinent Maint Taper Duration Follow-up Time NTX Abstinent post-taper Sigmon et al. 2013 70 2 wks 11.5mg 82% 1 wk 2 wk 4 wk 9 wks 8 wks 6 wks 50mg 21% 17% 50% Weiss et al. 2011 323 12 wks 20.8mg 54% 4 wks None 9.6% Ling et al. 2009 516 20.3mg 37% 18% Woody et al. 2008 55 15.1mg 6 months 34% Breen et al. 2003 50 2 wks (>6 months MMT) 8.6mg NR 11 wks Optional (N=5) 44% Bentzley et al. J Subst Abuse Treat 2015;52:48-57

Induction Strategies

Induction Strategies Office Home Patient centered approach becoming more widely implemented No need to time withdrawal around clinic schedule Fewer demands on space and clinic staff Standard used since introduction in U.S. Close monitoring for response and dose adjustments Appropriate for patients with limited social supports and unstable housing

Home Induction Protocol Lee JD et al. J Gen Intern Med 2009;24:226-232

Evidence for Home Induction J Subst Abuse Treat 2011 Jun; 40(4): 349–356