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Heroin Addiction and Related Clinical Problems: 2025, 27, 9

Retention rates in opioid maintenance treatment with methadone and buprenorphine – results from a 6-year observational study

Michael Soyka, Peggy Schmidt, Hans-Ulrich Wittchen, and Gerhard Bühringer

Digital Object Identifier:
https://doi.org/10.62401/2531-4122-2025-9

Summary: Background: For pharmacotherapy of opioid use disorder oral methadone and sublingual buprenorphine are approved first-line medications. An optimal retention rate is crucial for treatment outcome. Some previous studies suggest an overall lower adherence to treatment in patients treated with buprenorphine compared with methadone. Methods: This is a secondary analysis of data from a large naturalistic follow-up study in patients in opioid maintenance treatment. Here we report retention rates of patients treated either with methadone or buprenorphine in a 6-year noninterventional follow-up study in opioid maintenance therapy (N=1624). Results: There were no relevant baseline differences between patients in the methadone (N=1224) and buprenorphine (N=389) group. With respect to initial pharmacological treatment there were no significant differences concerning retention rates with 76.5% for buprenorphine and 73% for methadone between the two medications but more patients in the buprenorphine group switched to methadone (39.1%) than vice versa (8.0%), became abstinent or left opioid maintenance treatment. Mean dosages in both groups were rather low but stable over time (73 mg for methadone, 7mg for buprenorphine), with less transitions to other medications in methadone patients. Conclusions and scientific significance: Data indicate an overall high adherence to treatment over a six year period for both medications. Future studies may especially focus on adequate dose, psychosocial and setting factors modifying retention in opioid maintenance therapy.

Keywords: Opioids; opioid dependence; maintenance treatment; methadone; buprenorphine