Traditional Chinese medicine-based medication-assisted therapy for switching from methadone to buprenorphine/naloxone in treating opioid use disorder

Background: The switch from using methadone to buprenorphine/naloxone is challenging. Traditional Chinese medicine (TCM) herbal treatment may offer an alternative approach to medication-assisted therapy (MAT). Methods: Eight patients with heroin use disorder, who had been undergoing regular methadone maintenance treatment, were switched from using methadone to buprenorphine/naloxone in clinics of Taipei City Hospital, Linsen Chinese Medicine and Kunming branches. TCM diagnoses were formulated and herbal treatment was applied during the drug-switching period. Clinical manifestations of methadone dosage, opioid withdrawal symptoms based on the Clinical Opioid Withdrawal Scale (COWS) scores, and heart rate variability (HRV) in baseline and 2 months after herbal treatment were recorded. Results: After 4.0 ± 2.2 months of the TCM-facilitated treatment, the methadone dosage was gradually tapered from 21.0 ± 14.9 to 6.7 ± 4.7 mg daily, and was later switched to buprenorphine/naloxone. During the drug-switching period, no severe methadone or buprenorphine/naloxone-induced withdrawal symptoms were observed; what is more, both COWS scores and HRV improved. Conclusions: Traditional Chinese herbal medicine may offer an alternative approach to MAT when the decision has been taken to switch from the use of methadone to buprenorphine/naloxone.