There is no accepted algorithm to transfer opioid-dependent patients from methadone (METH) to its new alternative, buprenorphine (BUP). Five outpatients transferred (double blind, double dummy) from METH 60 mg/day (with one day at 45 mg) to BUP 8 mg s.l. tablet. Relative to METH maintenance, BUP decreased opioid agonist symptoms (transfer day 1) and increased withdrawal symptoms (days 1 and 2) and blood pressure (day 2). Self-reported heroin use did not increase from METH maintenance levels. It may be feasible to transfer outpatients on METH 60 mg/day to BUP 8 mg/day s.l. tablet, although this pilot protocol needs refinements to improve tolerability and clinical efficacy. (Am J Addict 2003;12:365-374)