Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence

February 2015
Mattick, R. P., Kimber, J., Breen, C. L., & Davoli, M. (2014). Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database of Systematic Reviews, 2. doi: 10.1002/14651858.CD002207.pub4

Methadone is widely used as a replacement for illicit opioid use such as heroin in medically -supported opioid substitution maintenance programs.

Buprenorphine is also currently used in treatment of opioid dependent patients and can reduce illicit opioid use compared with placebo, although it is less effective than methadone. Buprenorphine is an opioid drug that is not as potent as heroin and methadone, although the effects of buprenorphine may last longer. Buprenorphine can be taken once every two days.

The authors used Cochrane Collaboration methodology to evaluate the results of 31 randomised controlled trials of buprenorphine maintenance treatment versus placebo or methadone in management of opioid dependent persons.

The trials include different formulations of buprenorphine: sublingual solution, sublingual tablets, combined buprenorphine/naloxone sublingual tablet and an implant.

The review of trials found that buprenorphine at high doses (16 mg) can reduce illicit opioid use effectively compared with placebo, and buprenorphine at any dose studied retains people in treatment better than placebo.

Buprenorphine appears to be less effective than methadone in retaining people in treatment, if prescribed in a flexible dose regimen or at a fixed and low dose (2 - 6 mg per day).

Buprenorphine prescribed at fixed doses (above 7 mg per day) was not different from methadone prescribed at fixed doses (40 mg or more per day) in retaining people in treatment or in suppression of illicit opioid use.