Scolaris Content Display Scolaris Content Display

Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence

This is not the most recent version

Collapse all Expand all

Abstract

Background

Buprenorphine has been reported as an alternative to methadone and LAAM for maintenance treatment of opioid dependence, differing results are reported concerning its relative effectiveness indicating the need for an integrative review.

Objectives

To evaluate the effects of buprenorphine maintenance against placebo and methadone maintenance in retaining patients in treatment and in suppressing illicit drug use.

Search methods

We searched the following databases up to 2001, inclusive: Cochrane Drugs and Alcohol Review Group Register, the Cochrane Controlled Trials Register, MEDLINE, EMBASE, Current Contents, Psychlit, CORK [www. state.vt.su/adap/cork], Alcohol and Drug Council of Australia (ADCA) [www.adca.org.au], Australian Drug Foundation (ADF ‐VIC) [www.adf.org.au], Centre for Education and Information on Drugs and Alcohol (CEIDA) [www.ceida.net.au], Australian Bibliographic Network (ABN), Library of Congress databases, available NIDA monographs, the College on Problems of Drug Dependence Inc. proceedings, the reference lists of all identified studies and published reviews. Authors of identified RCT's were asked about any other published or unpublished relevant RCT.

Selection criteria

Randomised clinical trials of buprenorphine maintenance versus either placebo or methadone maintenance for opioid dependence.

Data collection and analysis

Reviewers evaluated the papers separately and independently, rating methodological quality of concealment of allocation; data were extracted independently for meta‐analysis and double‐entered.

Main results

Thirteen studies met the inclusion criteria, all were randomised clinical trials, all but one were double‐blind. The method of concealment of allocation was not clearly described in 11 of the studies, otherwise methodological quality was good. Buprenorphine given in flexible doses appeared statistically significantly less effective than methadone in retaining patient in treatment (RR= 0.82; 95% CI: 0.69‐0.96). Low dose buprenorphine is not superior to low dose methadone. High dose buprenorphine does not retain more patients than low dose methadone, but may suppress heroin use better. There was no advantage for high dose buprenorphine over high dose methadone in retention (RR=0.79; 95% CI:0.62‐1.01), and high dose buprenorphine was inferior in suppression of heroin use. Buprenorphine was statistically significantly superior to placebo medication in retention of patients in treatment at low doses (RR=1.24; 95% CI: 1.06‐1.45), high doses (RR=1.21; 95% CI: 1.02‐1.44), and very high doses (RR=1.52; 95% CI: 1.23‐1.88). However, only high and very high dose buprenorphine suppressed heroin use significantly above placebo.

Authors' conclusions

Buprenorphine is an effective intervention for use in the maintenance treatment of heroin dependence, but it is not more effective than methadone at adequate dosages.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Plain language summary

Buprenorphine can reduce heroin use, although it is not as effective as methadone

Methadone is the most widely used replacement for heroin in medically‐supported maintenance or detoxification programs. Two other drugs are sometimes used to try and help lower their use of heroin, buprenorphine and LAAM (levo‐alpha‐acetylmethadol). Buprenorphine is an opioid drug that is not as powerful as heroin and methadone, although the effects may last longer. It is easier to withdraw from buprenorphine than methadone, and can be taken once every two days. The review of trials found that buprehnorphine can reduce heroin use effectively, although it is not as effective as methadone.