Table 2.

Indications for detoxification, buprenorphine, or methadone

DETOXIFICATION	BUPRENORPHINE MAINTENANCE	METHADONE MAINTENANCE
Patient preference	Failed or had adverse effects with methadone	Failed or had adverse effects with buprenorphine
Good prognostic factors^*	Quickly relapsed after detoxification	Failed or had adverse effects with buprenorphine
Has not tried detoxification or has tried previously and had a good response	Good prognosis^*; might not need long-term opioid agonist treatment	Quickly relapsed after detoxification
	At higher risk of methadone toxicity^†	Intravenous buprenorphine abuse
	At higher risk of methadone toxicity^†	High risk of treatment dropout (socially unstable injection opioid user)

↵* Good prognostic factors include younger age, recent history, not addicted to other drugs, socially stable, oral use and no intravenous use, and no concurrent active psychiatric disorders.
↵† Those at higher risk of methadone toxicity include older patients, heavy drinkers, patients taking higher or unstable doses of benzodiazepines or other sedating drugs, those with respiratory illness (eg, chronic obstructive pulmonary disease), and those with lower opioid tolerance.