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Buprenorphine substitution to retain patients in treatment
Summary of the evidence
Buprenorphine substitution treatment was found to be more effective than placebo in a synthesis of evidence (WHO, 2009) and more recenlty in a systematic review (Mattick et al., 2014) in:
- improving retention in treatment
- at low doses (2-6mg) (RR 1.50, 95 % CI 1.19 to 1.88, 5 studies, N=1131);
- at medium doses (7-15mg) (RR 1.50, 95 % CI 1.19 to 1.88, 4 studies, N=887);
- at high doses (≥ 16mg) (RR 1.82, 95 % CI 1.15 to 2.90, 5 studies, N=1001)
A new systematic review with network meta-analysis (Lim et al., 2022, 79 RCTs) confirmed the results and found a significant overall effect of Buprenorphine compared to control in:
- retaining people in treatment (RR 2.15, 95 % CI 1.76 to 2.69)
- in the network analysis Methadone was the highest ranked intervention (Surface Under the Cumulative Ranking [SUCRA] = 0.901) with control being the lowest (SUCRA = 0.000). Methadone was superior to buprenorphine for treatment retention (RR = 1.22; 95% CI = 1.06-1.40) yet buprenorphine superior to naltrexone (RR = 1.39; 95% CI = 1.10-1.80).
