title: An overview of systematic reviews of the effectiveness of opiate maintenance therapies: available evidence to inform clinical practice and research.
abstract: OBJECTIVE
  To summarize the major findings of the five Cochrane reviews on substitution maintenance treatments for opioid dependence.
  
  
  METHODS
  We conducted a narrative and quantitative summary of systematic review findings. There were 52 studies included in the original reviews (12,075 participants, range 577-5894): methadone maintenance treatment (MMT) was compared with methadone detoxification treatment (MDT), no treatment, different dosages of MMT, buprenorphine maintenance treatment (BMT), heroin maintenance treatment (HMT), and l-alpha-acetylmethadol (LAAM) maintenance treatment (LMT).
  
  
  METHODS
  Outcomes considered were retention in treatment, use of heroin and other drugs during treatment, mortality, criminal activity, and quality of life.
  
  
  RESULTS
  Retention in treatment: MMT is more effective than MDT, no treatment, BMT, LMT, and heroin plus methadone. MMT proved to be less effective than injected heroin alone. High doses of methadone are more effective than medium and low doses. Use of heroin: MMT is more effective than waiting list, less effective than LAAM, and not different from injected heroin. No significant results were available for mortality and criminal activity.
  
  
  CONCLUSIONS
  These findings confirm that MMT at appropriate doses is the most effective in retaining patients in treatment and suppressing heroin use but show weak evidence of effectiveness toward other relevant outcomes. Future clinical trials should collect data on a broad range of health outcomes and recruit participants from heterogeneous practice settings and social contexts to increase generalizability of results.
authors.affiliation: Department of Epidemiology, 00198 Rome, Italy. amato@asplazio.it
authors.forename: Laura
authors.initials: L
authors.lastname: Amato
authors.forename: Marina
authors.initials: M
authors.lastname: Davoli
authors.forename: Carlo A
authors.initials: CA
authors.lastname: Perucci
authors.forename: Marica
authors.initials: M
authors.lastname: Ferri
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Faggiano
authors.forename: Richard P
authors.initials: RP
authors.lastname: Mattick
mesh_terms: D002047:Buprenorphine / Q000627:therapeutic use*; D006801:Humans; D033181:Information Dissemination; D008691:Methadone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D012106:Research; D016320:Substance Abuse Treatment Centers
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine; D008691:Methadone