Publication Highlights

Use of opioid agonist treatments for prescription opioid (PO) dependence is rapidly increasing. Current guidelines are based on research with heroin users. This study aimed to examine methadone and buprenorphine dose requirements for PO-dependent people.

The study design was a retrospective case series of 44 PO-dependent patients entering methadone and buprenorphine treatment. 67% of the patients were male, with a mean age 41 years. 69% reported a pain condition. Daily oral morphine equivalent (OME) doses at baseline were calculated using standard dose conversion calculations. Dose conversion tables were used to estimate opioid agonist doses, based on starting dose of PO. Baseline methadone and buprenorphine dose at days 7 and 28 were examined.

The patients treated with methadone (n = 21) had a mean PO dose of 704.5 mg OME (SD 783.5 mg) prior to treatment, with a mean methadone dose of 45.3 mg at day 7 and 61.6 mg (SD 20.8 mg) at day 28. The buprenorphine treatment group (n = 23) had a mean PO dose of 771.7 mg OME prior to treatment, with a mean dose of 14.6 mg at day 7 and 18.1 (SD 8.9 mg) at day 28. Linear relationships were not found between OME and opioid agonist dose.

Conclusion

Opioid agonist dosages varied substantially between individuals, and from predicted dosages based on dose conversion tables. Use of conversion tables to guide selection of opioid agonist dosage may compromise patient safety.