Evidence map›Paper›PMID 40591359›Full record

ArticleJAMA network open2025

Duration of Methadone and Buprenorphine-Naloxone Treatment.

Robert A Kleinman, Paul Kurdyak

Abstract read
In one paragraph

Article in JAMA network open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

2 authors.

Robert A KleinmanInstitute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
Paul KurdyakInstitute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Importance: Fentanyl has spread through the illicit opioid supply in Canada, driving increasing overdose deaths. However, the effectiveness of methadone and buprenorphine-naloxone in treating opioid use disorder during the fentanyl era is unknown. Objective: To evaluate methadone and buprenorphine-naloxone treatment duration, a core effectiveness outcome in the treatment of opioid use disorder, in Ontario, Canada, between 2014 and 2022. Design, Setting, and Participants: This population-based, retrospective cohort study included individuals who initiated methadone or buprenorphine-naloxone between January 2014 and December 2022 in Ontario, Canada. Data were analyzed from July 18, 2023, to June 11, 2025. Exposure: Period of medication initiation (2014-2016, 2017-2019, or 2020-2022). Main Outcomes and Measures: The main outcome was treatment duration, measured as time to medication discontinuation (5 consecutive days without dispensation of the initial opioid agonist treatment or availability of take-home doses). Results: The cohort included 72 717 new recipients of opioid agonist treatments (45 256 [62.2%] male; median [IQR] age, 35 [28-46] years), with 34 538 individuals (47.5%) receiving methadone and 38 179 individuals (52.5%) receiving buprenorphine-naloxone. Among individuals starting methadone, median treatment duration decreased from 193 (95% CI, 185-202) days in 2014 to 2016 to 139 (95% CI, 130-149) days in 2017 to 2019 and 86 (95% CI, 78-95) days in 2020 to 2022. Among individuals starting buprenorphine-naloxone, median treatment duration decreased from 51 (95% CI, 49-54) days in 2014 to 2016 and 50 (95% CI, 48-53) days in 2017 to 2019 to 38 (95% CI, 36-40) days in 2020 to 2022. In adjusted Cox regression models including time-varying effects and using 2014 to 2016 as the reference period, hazards of discontinuation measured at treatment initiation were higher during later periods of methadone initiation (2017-2019: adjusted hazard ratio [aHR], 1.18 [95% CI, 1.15-1.22]; P < .001; 2020-2022: aHR, 1.45 [95% CI, 1.39-1.51]; P < .001) and for buprenorphine-naloxone initiation in 2020 to 2022 (aHR, 1.11 [95% CI, 1.08-1.15]; P < .001). Age categories, neighborhood income quintile, rurality, sex, and number of comorbidities were also associated with time to discontinuation in adjusted models. Conclusions and Relevance: This cohort study found that treatment duration among individuals starting methadone and buprenorphine-naloxone during 2020 to 2022 was lower than during 2014 to 2016. This study highlights the importance of ongoing evaluation of treatment effectiveness, given the dynamic nature of the opioid crisis. Further research is needed to improve treatment retention and improve the effectiveness of opioid use disorder treatment.

Indexed as

Buprenorphine, Naloxone Drug CombinationDuration of TherapyMethadoneNarcotic AntagonistsOpiate Substitution TreatmentOpioid-Related DisordersAdultFemaleHumansMaleMiddle AgedOntarioRetrospective StudiesTime FactorsBuprenorphine, Naloxone Drug CombinationMethadoneNarcotic Antagonists

Identifiers

PMID40591359
PMCPMC12215571

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.