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Buprenorphine Maintenance vs. Placebo for Opioid Dependence

 

Am Fam Physician. 2017 Mar 1;95(5):online.

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BUPRENORPHINE MAINTENANCE VS. PLACEBO FOR OPIOID DEPENDENCE

BenefitsHarms

1 in 4 using low-dose buprenorphine (2 to 6 mg) had retention in treatment

No study-related medication mortality was reported

1 in 3 using medium-dose buprenorphine (7 to 16 mg) had retention in treatment

Uncertain adverse effects

1 in 2 using high-dose buprenorphine (≥ 16 mg) had retention in treatment

BUPRENORPHINE MAINTENANCE VS. PLACEBO FOR OPIOID DEPENDENCE

BenefitsHarms

1 in 4 using low-dose buprenorphine (2 to 6 mg) had retention in treatment

No study-related medication mortality was reported

1 in 3 using medium-dose buprenorphine (7 to 16 mg) had retention in treatment

Uncertain adverse effects

1 in 2 using high-dose buprenorphine (≥ 16 mg) had retention in treatment

Details for This Review

Study Population: Adults with opioid dependence

Efficacy End Points: Treatment retention and illicit drug use suppression

Harm End Points: Mortality and adverse effects

Narrative: The United States is facing an opioid epidemic. Since 1999, overdose deaths involving opioids and heroin have quadrupled.1 Methadone, a full agonist, has traditionally been used to treat opioid and heroin dependence. Buprenorphine, a partial agonist, is an appealing alternative because it causes lower physical dependence, milder withdrawal symptoms, and is less likely to cause an overdose.2 This review examines the effectiveness of buprenorphine vs. placebo for retention in treatment and illicit opioid use, as measured by positive urinalysis or self-reported use.

This Cochrane review included 31 studies with 5,430 participants, the majority of whom were male with an average age of 30 years.2 High-quality evidence shows that buprenorphine at all doses is more effective than placebo in retaining patients in treatment. An analysis of five studies using low-dose buprenorphine (2 to 6 mg) in 1,131 participants showed a benefit in treatment retention over placebo (relative risk [RR] = 1.5; 95% confidence interval [CI], 1.19 to 1.88). Medium-dose buprenorphine (7 to 16 mg) had slightly better patient retention in treatment (RR = 1.74; 95% CI, 1.06 to 2.87). High-dose buprenorphine (≥ 16 mg) was the most effective at retaining

Author disclosure: No relevant financial affiliations.

REFERENCES

1. CDC National Vital Statistics System. The opioid epidemic: by the numbers. http://www.hhs.gov/sites/default/files/Factsheet-opioids-061516.pdf. Accessed June 1, 2016.

2. Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2014;(2):CD002207.

 

 

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