1. 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

2. 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:

3. 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

4. Induction Strategies

5. 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

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

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