Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence

Mattick, Richard P.; Kimber, Jo; Breen, Courtney; Davoli, Marina

doi:10.1002/14651858.cd002207.pub3

Cited by 311 publications

(137 citation statements)

References 50 publications

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“…This association has been reported by systematic reviews 19, 35. A recent Australian cohort study of OST patients reported that the risk of death during the first 4 weeks was lower for buprenorphine compared to methadone—with no marked differences in mortality risk thereafter 24—but with a shorter duration of treatment for patients on buprenorphine compared to methadone 21, 36, 37.…”

Section: Introductionsupporting

confidence: 68%

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

et al. 2018

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AimsTo estimate whether opioid substitution treatment (OST) with buprenorphine or methadone is associated with a greater reduction in the risk of all‐cause mortality (ACM) and opioid drug‐related poisoning (DRP) mortality.DesignCohort study with linkage between clinical records from Clinical Practice Research Datalink and mortality register.SettingUK primary care.ParticipantsA total of 11 033 opioid‐dependent patients who received OST from 1998 to 2014, followed‐up for 30 410 person‐years.MeasurementsExposure to methadone (17 373, 61%) OST episodes or buprenorphine (9173, 39%) OST episodes. ACM was available for all patients; information on cause of death and DRP was available for 5935 patients (54%) followed‐up for 16 363 person‐years. Poisson regression modelled mortality by treatment period with an interaction between OST type and treatment period (first 4 weeks on OST, rest of time off OST, first 4 weeks off OST, rest of time out of OST censored at 12 months) to test whether ACM or DRP differed between methadone and buprenorphine. Inverse probability weights were included to adjust for confounding and balance characteristics of patients prescribed methadone or buprenorphine.FindingsACM and DRP rates were 1.93 and 0.53 per 100 person‐years, respectively. DRP was elevated during the first 4 weeks of OST [incidence rate ratio (IRR) = 1.93 95% confidence interval (CI) = 0.97–3.82], the first 4 weeks off OST (IRR = 8.15, 95% CI = 5.45–12.19) and the rest of time out of OST (IRR = 2.13, 95% CI = 1.47–3.09) compared with mortality risk from 4 weeks to end of treatment. Patients on buprenorphine compared with methadone had lower ACM rates in each treatment period. After adjustment, there was evidence of a lower DRP risk for patients on buprenorphine compared with methadone at treatment initiation (IRR = 0.08, 95% CI = 0.01–0.48) and rest of time on treatment (IRR = 0.37, 95% CI = 0.17–0.79). Treatment duration (mean and median) was shorter on buprenorphine than methadone (173 and 40 versus 363 and 111, respectively). Model estimates suggest that there was a low probability that methadone or buprenorphine reduced the number of DRP in the population: 28 and 21%, respectively.ConclusionsIn UK general medical practice, opioid substitution treatment with buprenorphine is associated with a lower risk of all‐cause and drug‐related poisoning mortality than methadone. In the population, buprenorphine is unlikely to give greater overall protection because of the relatively shorter duration of treatment.

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Section: Introductionsupporting

confidence: 68%

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

et al. 2018

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“…Maintenance treatment with full or partial opioid agonists reduces opioid consumption, criminal behavior and psychosocial and medical morbidity, including rates of HIV and hepatitis B virus infections, as indicated by many studies and meta-analyses [78,79,80,81,82,83,84]. The efficacy of buprenorphine and its combination with naloxone in reducing substance use and improving social and clinical functioning in opioid-dependent individuals has been demonstrated by numerous studies [84,85,86,87] and both methadone and buprenorphine are recommended as effective, first-line medications in the treatment of opioid dependence by relevant treatment guidelines [5,88,89,90] and reviews [78,80,82,83,85,91]. …”

Section: Brief Update On the Efficacy Of Maintenance Treatmentmentioning

confidence: 99%

Alcohol Use Disorders in Opioid Maintenance Therapy: Prevalence, Clinical Correlates and Treatment

Soyka¹

2014

Eur Addict Res

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Maintenance therapy with methadone or buprenorphine is an established and first-line treatment for opioid dependence. Clinical studies indicate that about a third of patients in opioid maintenance therapy show increased alcohol consumption and alcohol use disorders. Comorbid alcohol use disorders have been identified as a risk factor for clinical outcome and can cause poor physical and mental health, including liver disorders, noncompliance, social deterioration and increased mortality risk. The effects of opioid maintenance therapy on alcohol consumption are controversial and no clear pattern has emerged. Most studies have not found a change in alcohol use after initiation of maintenance therapy. Methadone and buprenorphine appear to carry little risk of liver toxicity, but further research on this topic is required. Recent data indicate that brief intervention strategies may help reduce alcohol intake, but the existing evidence is still limited. This review discusses further clinical implications of alcohol use disorders in opioid dependence.

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“…In this country, methadone maintenance treatment (MMT), the most recommended response to heroin addiction [1,2], is generally available and is reimbursed by social insurance. General practitioners can prescribe methadone in private practice or in health institutions, but the organisation of this treatment is not centralised and can differ between regions.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Heroin-Assisted Treatment in Belgium: A Randomised Controlled Trial

et al. 2015

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Background/Aims: Heroin-assisted treatment (HAT) can improve the condition of heroin addicts still using street heroin after a methadone treatment. In Belgium, a new trial compared the efficacy of a HAT to existing methadone maintenance treatment. Methods: In this randomised controlled trial, HAT was limited to 12 months. Participants were assessed every 3 months. They were responders if they showed improvement on the level of street heroin use, health or criminal involvement. Results: 74 participants were randomised in the trial. The experimental group (n = 36) counted 30% of responders more than the control group (n = 38) at each assessment point (p < 0.05), except at 12 months where the difference (11%) was no longer significant (p = 0.35). Still, after 12 months, participants in the experimental group reported significantly greater improvements (p < 0.05) than the control group on the level of street heroin use and on the level of physical and mental health. Both groups reported significantly less criminal acts after 12 months (p < 0.001), but with no significant difference between the groups. Conclusions: This trial confirms the short-term efficacy of HAT for severe heroin addicts, who already failed methadone treatment.

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Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence

Cited by 311 publications

References 50 publications

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

The impact of buprenorphine and methadone on mortality: a primary care cohort study in the United Kingdom

Alcohol Use Disorders in Opioid Maintenance Therapy: Prevalence, Clinical Correlates and Treatment

Efficacy of Heroin-Assisted Treatment in Belgium: A Randomised Controlled Trial

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