Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence (2004)

[Jatelka]

A new entry has been added to Drugs Archive

Description:
Cochrane Review

Mattick RP, Kimber J, Breen C, Davoli M.

BACKGROUND: Buprenorphine has recently been reported to be an alternative to methadone and LAAM for maintenance treatment of opioid dependent individuals, differing results are reported concerning its relative effectiveness indicating the need for an integrative review.

OBJECTIVES: To evaluate the effects of buprenorphine maintenance against placebo and methadone maintenance in retaining patients in treatment and in suppressing illicit drug use.

SEARCH STRATEGY: We searched the following databases up to 2001, inclusive: Cochrane Drugs and Alcohol Review Group Register, the Cochrane Controlled Trials Register, MEDLINE, EMBASE, Current Contents, Psychlit, CORK [www. state.vt.su/adap/cork], Alcohol and Drug Council of Australia (ADCA) [www.adca.org.au], Australian Drug Foundation (ADF -VIC) [www.adf.org.au], Centre for Education and Information on Drugs and Alcohol (CEIDA) [www.ceida.net.au], Australian Bibliographic Network (ABN), and Library of Congress databases, available NIDA monographs and the College on Problems of Drug Dependence Inc. proceedings, the reference lists of all identified studies and published reviews and authors of identified RCT's were asked about any other published or unpublished relevant RCT.

SELECTION CRITERIA: Randomised clinical trials of buprenorphine maintenance compared with either placebo or methadone maintenance for opioid dependence.

DATA COLLECTION AND ANALYSIS: Reviewers evaluated the papers separately and independently, rating methodological quality of concealment of allocation; data were extracted independently for meta-analysis and double-entered. MAIN RESULTS: Thirteen studies met the inclusion criteria, all were randomised clinical trials, all but one were double-blind. The method of concealment of allocation was not clearly described in 11 of the studies, otherwise methodological quality was good. Buprenorphine given in flexible doses appeared statistically significantly less effective than methadone in retaining patient in treatment (RR= 0.82; 95% CI: 0.69-0.96). Low dose buprenorphine is not superior to low dose methadone. High dose buprenorphine does not retain more patients than low dose methadone, but may suppress heroin use better. There was no advantage for high dose buprenorphine over high dose methadone in retention (RR=0.79; 95% CI:0.62-1.01), and high dose buprenorphine was inferior in suppression of heroin use. Buprenorphine was statistically significantly superior to placebo medication in retention of patients in treatment at low doses (RR=1.24; 95% CI: 1.06-1.45), high doses (RR=1.21; 95% CI: 1.02-1.44), and very high doses (RR=1.52; 95% CI: 1.23-1.88). However, only high and very high dose buprenorphine suppressed heroin use significantly above placebo.

REVIEWERS' CONCLUSIONS: Buprenorphine is an effective intervention for use in the maintenance treatment of heroin dependence, but it is not more effective than methadone at adequate dosages.

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[helene]

Comment:

"However, only high and very high dose buprenorphine suppressed heroin use significantly above placebo." - eh?

So people on low dose bup may as well be taking sugar tablets..? This seems kinda odd to me. Heroin withdrawal isn't just psychological, that much has been proven - there's many documented physiological symptons.

Slightly confused by the above. Still, at least the bup = wonder-drug thing is wearing off.

To check this out, and rate it or add your own comments, visit Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence (2004).
The comments you make there will appear in the posts below.

[missparkles]

Originally Posted by helene

Heroin withdrawal isn't psychological, that much has been proven - there's many documented physiological symptons.

W/D has many psychological symptoms. Cravings, anxiety, depression and dysphoria. These are all present in W/D and they're all psychological. To say it's been proven that these don't exist, is rubbish.
Sparkles.

[helene]

Er...that wasn't my intended point at all, sorry, maybe not explaining myself too well. Try again -

Didn't mean proving psychological symptons don't exist, more to the point proving physiological symptons do exist. As well. If you see what I mean...

Basically it's not all "in your head", as some idiotic doctors used to enjoy telling addicts.

H

helene added 8 Minutes and 26 Seconds later...

i.e. there are real, physiological, physical symptons of heroin withdrawal. Obviously these symptons can be brought on by psychological causes, as with many things, but they manifest in real, physical symptons.

What I didn't understand was how a placebo could possibly stave off the hard and fast physiological w/d symptons, as opposed to the mental cravings etc.

Errr...been up all night, not very well, perhaps shouldn't be trying to articulate myself at the moment...sorry!

[missparkles]

No problem Helene...it's an extremely contentious, awkward topic to make sense of.
I think a placebo will stave off W/Ds because the person taking it is prepared to believe it. The mind is an intricate, and as yet, still misunderstood and least understood part of the human body.
I also thinks addiction is 100% in a persons head once W/D is over. But once when Sparkles had been clean for 3 years she saw someone using, that started immediate cravings and she even felt slight W/Ds. She used soon after this. She's sure the yawning, aches, sickness and itchy skin were real...were they...or were they psychological?
She wonders?
Take care.
Sparkles.