Home > Buprenorphine for managing opioid withdrawal.

Gowing, Linda and Ali, Robert and White, Jason M (2017) Buprenorphine for managing opioid withdrawal. Cochrane Database of Systematic Reviews, (2), DOI: 10.1002/14651858.CD002025.pub5.

External website: http://onlinelibrary.wiley.com/doi/10.1002/1465185...

Review question: We reviewed the evidence about the effect of buprenorphine for managing withdrawal in people who are dependent on opioid drugs (for example, heroin or pharmaceutical opiates).


Background: Managed withdrawal, or detoxification, is a required first step for long-term treatment of opioid dependence. The combination of uncomfortable symptoms and intense craving makes completion of opioid withdrawal difficult for most people. Buprenorphine is one of the medications used to manage withdrawal from opioid drugs. This review considered whether buprenorphine is more effective than methadone in tapered doses, or better than clonidine or lofexidine, which are other medications that have been commonly used for managing opioid withdrawal.


Study characteristics: We identified 27 randomised controlled trials (clinical studies where people are randomly put into one of two or more treatment groups), involving 3048 opioid-dependent participants. For 21 studies the average age of participants was in the range 25 to 40 years − in one study the average age was 47 years, while in two studies involving adolescents, the average age of participants was in the range 17 to 20 years (3 studies did not report the average age of participants). In four studies, all or nearly all participants were male, while in three studies less than half the participants were male. In most studies males comprised between one half and three-quarters of participants, a balance that is typical of the population of people who are opioid dependent. Fourteen of the studies took place in the USA, while the remaining studies were in eight other countries. The studies compared buprenorphine with methadone (6 studies), clonidine or lofexidine (14 studies), or different rates of buprenorphine dose reduction (7 studies). Fourteen studies reported funding from sources other than industry; in seven studies funding or medications were provided by a pharmaceutical company. The funding source was unclear for seven studies.


Key results: Compared to clonidine or lofexidine, people receiving buprenorphine for opioid withdrawal will have less severe signs and symptoms, be likely to stay in treatment longer, experience fewer side effects, and be more likely to complete the scheduled period of treatment. The effectiveness of buprenorphine is probably similar to tapered doses of methadone, but we are uncertain whether withdrawal symptoms resolve more quickly with buprenorphine. We are also uncertain whether rapid reduction in the dose of buprenorphine is more effective than slow reduction and whether this depends on the context of withdrawal.


Quality of the evidence: We assessed the quality of the evidence to be very low to moderate for the comparison of buprenorphine versus clonidine or lofexidine, low to moderate for the comparison of buprenorphine versus methadone, and very low to low for the comparison of different rates of dose reduction. Further evidence could change the findings, particularly for buprenorphine compared to methadone and for different rates of reduction of buprenorphine dose.

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