The physical, psychological and social implications of opiate dependency are well known. A variety of treatment approaches, including behavioural therapy, social skills and stress management have been used. The pharmacotherapeutic approach, using methadone maintenance therapy, has proved most beneficial to date and is the mainstay of treatment in the Irish setting. A systematic review was undertaken in order to evaluate the potential usefulness of buprenorphine as an intervention in the treatment of opiate dependency. All available data were retrieved by means of a comprehensive search of the published literature and clinical trials databases. Authors of pivotal studies were contacted for further information, for inclusion in a meta analysis. Contact was made with experts in the UK and France, to evaluate the practical issues associated with buprenorphine in a clinical setting. Pharmacoeconomic data were retrieved from the GMS, ERHA and the manufacturer for the purposes of analysis.

The results of the clinical trials evaluation showed that buprenorphine appeared to have potential in the management of opiate dependence. It was shown to be at least as effective as other treatment regimens (clonidine and lofexidine) in treating managed opiate withdrawal (detoxification). Buprenorphine (at doses of >8mg/day) was as effective as methadone as a maintenance treatment option. It was not possible to define the optimal dosage regimen for either indication, but treatment appeared to be most effective when dosage was titrated to the individual's needs. Because of its pharmacological profile, less than daily dosing (e.g. thrice weekly) is a possible dosing option.

Evaluation of its use in clinical practice showed that it was considered as effective as methadone for maintenance treatment, had a better safety profile but had more abuse potential. Accordingly, supervised dispensing was recommended by many experts, especially in the early months of treatment. Experience of its use in managed opiate withdrawal was more limited but was also favourable. The review suggests that buprenorphine may be viewed as an effective treatment option in the management of opiate dependence syndrome, with an acceptable safety profile.