Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence

Mattick, RP; Kimber, Jo; Breen, C; Davoli, Marina

doi:10.1002/14651858.cd002207

Cited by 566 publications

(789 citation statements)

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“…While any dose above 2 mg retains participants in treatment, at least 16 mg is necessary to suppress illicit opioid use. [23] An encouraging finding was that the vast majority (88.1%) of the participants knew their HIV status, and more than a third had been tested within the past year. Similar positive findings were highlighted by South African Community Epidemiology Network on Drug Use (SACENDU) data [9] and may reflect successes made in community education pertaining to opioid use disorder as well as provision of access to confidential testing facilities.…”

Section: Discussionmentioning

confidence: 91%

Report on the first government-funded opioid substitution programme for heroin users in the Western Cape Province, South Africa

Michie

Hoosain²,

Macharia

et al. 2017

S Afr Med J

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Background. Although pharmacological opioid substitution treatment (OST) is a well-established treatment modality for heroin addiction, it is a relatively recent introduction in low-and middle-income countries. Objective. To report on a pilot OST programme initiated in 2013 that was the only public-funded programme in South Africa (SA) at the time. Participants were offered standard care only (n=68) or, for the OST group (n=67), standard care plus Suboxone (Reckitt Benckiser), a synthetic partial opioid agonist, in a 12-week clinician-monitored programme. Methods. Clinical records of 135 participants in the rehabilitation programme at Sultan Bahu Rehabilitation Centre in Mitchell's Plain, Cape Town, SA, from 1 January to 31 December 2014 were reviewed. Data collected included demographics and duration in treatment (retention) as well as number of urine samples provided, positive tests or self-reported use events and dates of first positive/negative tests. Results. Significantly more participants in the OST group (65.7%) than controls (44.1%) completed the treatment (p=0.019). Among the non-completers, retention was higher in the OST group than in the standard care group (48.2 v. 30.1 days; p=0.001). The groups did not differ in respect of number of missed appointments and time to first positive test. However, the proportion of participants testing positive was higher in the OST group (80.6%) than in the standard care group (61.8%), although the former were tested nearly three times (18.3 v. 6.6 times) more. Consequently, the positive rate (proportion of positive tests) was substantially lower in the OST group (16.8%) than in the standard care group (23.3%).Conclusions. The results demonstrate modest success of this pilot OST programme in terms of completion and retention and should argue for a move to increase availability of and accessibility to OSTs for the management of opioid use disorder.

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Section: Discussionmentioning

confidence: 91%

Report on the first government-funded opioid substitution programme for heroin users in the Western Cape Province, South Africa

Michie

Hoosain²,

Macharia

et al. 2017

S Afr Med J

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“…Although psychotherapy and psychosocial treatment are effective in substance use disorders [34,] opioid maintenance therapy is a well-established first-line treatment and widely used for opioid dependence [16,23] and is recommended by numerous treatment guidelines [10,18,35,36,37]. …”

Section: Discussionmentioning

confidence: 99%

“…In general, there is substantial clinical evidence that opioid maintenance treatment has proven efficacy in reducing opioid consumption, psychosocial and medical morbidity and in increasing treatment retention rates and social functioning in opioid addicts also in the long run [16,23]. …”

Section: Discussionmentioning

confidence: 99%

“…Although a number of long-term studies have been performed in opioid-dependent individuals [41,42] and numerous short-term clinical and experimental studies have examined the efficacy of opioid maintenance therapy [16,23], relatively few studies have studied opioid-dependent patients in opioid maintenance treatment over long time periods. Fifteen-year follow-up data from a small group of Swedish methadone patients indicate that an opiate-free life can be achieved [43], but most studies agree that opioid-dependent patients with and without maintenance therapy have a high risk for inpatient treatments and detoxification [44].…”

Section: Discussionmentioning

confidence: 99%

“…Methadone, buprenorphine or the combination of buprenorphine and naloxone is frequently used [15,16,17,18,19]. Methadone and buprenorphine have proven efficacy and are widely used in opioid dependence [review by [16,20,21,22,23,24].…”

Section: Introductionmentioning

confidence: 99%

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Six-Year Outcome of Opioid Maintenance Treatment in Heroin-Dependent Patients: Results from a Naturalistic Study in a Nationally Representative Sample

et al. 2017

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Background: In many countries, the opioid agonists, buprenorphine and methadone, are licensed for maintenance treatment of opioid dependence. Many short-term studies have been performed, but little is known about long-term effects. Therefore, this study described over 6 years (1) mortality, retention and abstinence rates and (2) changes in concomitant drug use and somatic and mental health. Methods: A prevalence sample of n = 2,694 maintenance patients, recruited from a nationally representative sample of n = 223 substitution doctors, was evaluated in a 6-year prospective-longitudinal naturalistic study. At 72 months, n = 1,624 patients were assessed for outcome; 1,147 had full outcome data, 346 primary outcome data and 131 had died; 660 individuals were lost to follow-up. Results: The 6-year retention rate was 76.6%; the average mortality rate was 1.1%. During follow-up, 9.4% of patients became “abstinent” and 1.9% were referred for drug-free addiction treatment. Concomitant drug use decreased and somatic health status and social parameters improved. Conclusions: The study provides further evidence for the efficacy and safety of maintenance treatment with opioid agonists. In the long term, the number of opioid-free patients is low and most patients are more or less continuously under opioid maintenance therapy. Further implications are discussed.

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CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016

Dowell

Haegerich

Chou

2016

JAMA

3,223

1,889

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IMPORTANCE Primary care clinicians find managing chronic pain challenging. Evidence of long-term efficacy of opioids for chronic pain is limited. Opioid use is associated with serious risks, including opioid use disorder and overdose. OBJECTIVE To provide recommendations about opioid prescribing for primary care clinicians treating adult patients with chronic pain outside of active cancer treatment, palliative care, and end-of-life care. PROCESS The Centers for Disease Control and Prevention (CDC) updated a 2014 systematic review on effectiveness and risks of opioids and conducted a supplemental review on benefits and harms, values and preferences, and costs. CDC used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to assess evidence type and determine the recommendation category. EVIDENCE SYNTHESIS Evidence consisted of observational studies or randomized clinical trials with notable limitations, characterized as low quality using GRADE methodology. Meta-analysis was not attempted due to the limited number of studies, variability in study designs and clinical heterogeneity, and methodological shortcomings of studies. No study evaluated long-term (≥1 year) benefit of opioids for chronic pain. Opioids were associated with increased risks, including opioid use disorder, overdose, and death, with dose-dependent affects. RECOMMENDATIONS There are 12 recommendations. Of primary importance, nonopioid therapy is preferred for treatment of chronic pain. Opioids should be used only when benefits for pain and function are expected to outweigh risks. Before starting opioids, clinicians should establish treatment goals with patients and consider how opioids will be discontinued if benefits do not outweigh risks. When opioids are used, clinicians should prescribe the lowest effective dosage, carefully reassess benefits and risks when considering increasing dosage to 50 morphine milligram equivalents or more per day, and avoid concurrent opioids and benzodiazepines whenever possible. Clinicians should evaluate benefits and harms of continued opioid therapy with patients every 3 months or more frequently and review prescription drug monitoring program data, when available, for high-risk combinations or dosages. For patients with opioid use disorder, clinicians should offer or arrange evidence-based treatment, such as medication-assisted treatment with buprenorphine or methadone. CONCLUSIONS AND RELEVANCE The guideline is intended to improve communication about benefits and risks of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risks associated with long-term opioid therapy.

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Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence

Abstract: Mattick, RP; Kimber, J; Breen, C; Davoli, M (2003) Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev, 2 (2).

Cited by 566 publications

References 0 publications

Report on the first government-funded opioid substitution programme for heroin users in the Western Cape Province, South Africa

Report on the first government-funded opioid substitution programme for heroin users in the Western Cape Province, South Africa

Six-Year Outcome of Opioid Maintenance Treatment in Heroin-Dependent Patients: Results from a Naturalistic Study in a Nationally Representative Sample

CDC Guideline for Prescribing Opioids for Chronic Pain—United States, 2016

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