Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence

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 strategy 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 Authors of identified RCT's were asked about any other published or unpublished relevant RCT.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).

Patient views of opioid pharmacotherapy biodelivery systems: Qualitative study to assist treatment decision making.

“…There is an extensive literature evaluating and comparing different types of OPT, but studies are largely confined to analyses of detoxification versus maintenance, and assessments of specific medicines, such as methadone, buprenorphine, lofexidine, levomethadyl acetate (LAAM), and naltrexone (Kleber, 2007;Mattick et al, 2014;Stotts et al, 2009). Whilst most of this literature is based on biomedical or clinical studies, social scientists have used qualitative and quantitative methods to capture both treatment provider perspectives (e.g.…”

Effectiveness of treatment for opioid use disorder: A national, five-year, prospective, observational study in England

“…The opioid medications methadone and buprenorphine are front-line, randomisedcontrolled trial supported pharmacotherapies (Mattick et al, 2014(Mattick et al, , 2009). Some OUD patients may receive psychosocial interventions without opioid psychotherapy.…”

A Systematic, Intensive Statistical Investigation of Data from the Comprehensive Analysis of Reported Drugs (CARD) for Compliance and Illicit Opioid Abstinence in Substance Addiction Treatment with Buprenorphine/naloxone

“…While at 16 mg or more per day, buprenorphine was found to reduce illicit substance use compared with placebo as monitored by urinalysis. However, buprenorphine retains fewer people compared to methadone, when doses are low and fixed or flexibly delivered (Mattick, Breen, Kimber, & Davoli, 2014).…”

“…Other studies have focused on meaningful comparisons regarding treatment modalities, efficacy methadone vs. bup/nal, and determination of risk factors for compliance and treatment success. Many of these studies have used short follow-up periods, and researchers have focused largely on retention rates, chart reviews, instances of buprenorphine administration, interviews, self-report of heroin use and criminal activity, and telephone or internet communication, to measure adherence and abstinence (Fareed et al, 2014;Maas, Barton, Maskrey, Pinto, & Holland, 2013;Mattick et al, 2014;Moore et al, 2016;Parran et al, 2010;Tkacz, Severt, Cacciola, & Ruetsch, 2012).…”