Addressing the efficacy of dihydrocodeine versus methadone as an alternative maintenance treatment for opiate dependence: A randomized controlled trial

Division of Community Health Sciences, University of Edinburgh, Edinburgh, UK.
Addiction (Impact Factor: 4.74). 01/2007; 101(12):1752-9. DOI: 10.1111/j.1360-0443.2006.01603.x
Source: PubMed


The aim of this study is to define the efficacy of dihydrocodeine as an alternative to methadone in the maintenance treatment of opiate dependence.
A pragmatic open-label randomized controlled study of patients recommended for opiate maintenance treatment to test equivalence of the two treatment options with follow-up continuing for up to 42 months after recruitment.
Assessment at either Edinburgh's Community Drug Problem Service or at two general practitioner practices with specialist drug community psychiatric nurses, then with shared care follow-up.
Two hundred and thirty-five subjects (168 male, 67 female) with opiate dependence syndrome were recruited. Subjects selected were suitable for opiate maintenance treatment. Routine treatment was offered throughout.
Patients were randomized to receive either methadone mixture 1 mg/ml or dihydrocodeine, 30 mg or 60 mg tablets.
The primary outcome measure was retention in treatment. Eight secondary outcomes included total illicit opiate use, reported crime, physical health, mental health, injecting drug use, overdoses, selling drugs and being in education or work. Measures were compared over 42 months follow-up.
There was no difference in groups for retention in treatment at follow-up and there was improvement in all secondary outcomes from baseline. No significant difference in outcomes was found between randomized groups over time. Compliance with randomized treatment differed by randomized group and was affected by experiences in custody during follow-up. Those randomized to dihydrocodeine were more likely to switch treatments.
These results, combined with existing clinical experience, provide evidence that dihydrocodeine is a viable alternative to methadone as a maintenance treatment for opiate dependence. Indirect comparisons with other studies show dihydrocodeine (and methadone) to be superior to placebo.

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    • "A single RCT from the UK of dihydrocodeine (30 mg equivalent to 2.5 mg methadone) and methadone showed dihydrocodeine had a similar treatment retention rate to methadone . There was no difference in other measured outcomes, but there was a lot of switching in the dihydrocodeine group to methadone (Robertson et al., 2006) (Ib). "
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    • "Most experts believe that its outpatient use is obsolete. The use of DHC for opiate addicts is, despite published good data (Ulmer, 1997; Krausz et al., 1998; Robertson et al., 2006), similarly restricted in Germany, and has been reduced from ca. 80 to 0.3% (Bundesinstitut für Arzneimittel und Medizinprodukte, 2011). "
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    • "Dihydrocodeine has been attractive to clinicians as it has a shorter half-life than methadone, and seems equally acceptable to users. Robertson et al (2006) found that there was no significant difference in retention in treatment between dihydrocodeine and methadone for maintenance treatment in the community [11]. Towards the end of the study period (late 2005), there was a national move away from prescribing dihydrocodeine in the British prison setting due to its potential for diversion by prisoners into the shadow economy. "
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