What is the evidence for buprenorphine versus placebo in opioid use disorder?
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- Answered 4 Nov 2019 Conflict of interest declaration: None Cochrane published, in 2014, “Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence” , this reported: “Buprenorphine is an effective medication in the maintenance treatment of heroin dependence, retaining people in treatment at any dose above 2 mg, and suppressing illicit opioid use (at doses 16 mg or greater) based on placebo‐controlled trials.” A more recent (2018) review by the National Institute on Drug Abuse, “Medications to Treat Opioid Use Disorder” , this includes the following: “A Swedish study compared patients maintained on 16 mg of buprenorphine daily to a control group that received buprenorphine for detoxification (6 days) followed by placebo. All patients received psychosocial supports. In this study, the treatment failure rate for placebo was 100 percent vs. 25 percent for buprenorphine. More than two opioid-positive urine tests within 3 months resulted in cessation of treatment, so treatment retention was closely related to relapse. Of patients not retained in treatment, there was a 20 percent mortality rate. Meta-analysis determined that patients on doses of buprenorphine of 16 mg per day or more were 1.82 times more likely to stay in treatment than placebo-treated patients, and buprenorphine decreased the number of opioid-positive drug tests by 14.2 percent (the standardized mean difference was -1.17).” References 1) https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD002207.pub4/abstract 2) https://www.drugabuse.gov/node/pdf/21349/medications-to-treat-opioid-use-disorder