Heroin anticraving medications: a systematic review.
BACKGROUND
Heroin craving is a trigger for relapse and dropping out of treatment. Methadone has been the standard medication for the management of heroin craving.


OBJECTIVE
We explored the medication options other than methadone which may have heroin anticraving properties.


METHODS
To be selected for the review, articles had to include outcome measures of the effect of the studied medication on subjective and/or objective opiate craving and be of the following two types: (1) randomized, controlled, and/or double-blind clinical trials (RCTs) examining the relationship between the studied medication and heroin craving; (2) nonrandomized and observational studies (NRSs) examining the relationship between the studied medication and heroin craving. Thirty-three articles were initially included in the review. Twenty-one were excluded because they did not meet the inclusion criteria. We present the results of 12 articles that met all the inclusion criteria.


RESULTS
Some new medications have been under investigation and seem promising for the treatment of opiate craving. Buprenorphine is the second most studied medication after methadone for its effect on opiate craving. At doses above 8 mg daily, it seems very promising and practical for managing opiate craving in patients receiving long-term opioid maintenance treatment.


CONCLUSIONS
In doses higher than 8 mg daily, buprenorphine is an appropriate treatment for opiate craving. More research with rigorous methodology is needed to study the effect of buprenorphine on heroin craving. Also more studies are needed to directly compare buprenorphine and methadone with regard to their effects on heroin craving.
Department of Psychiatry, Emory University, School of Medicine/Atlanta VA Medical center, Decatur, GA 30033, USA. ayman.fareed@va.gov
Ayman
A
Fareed
Sreedevi
S
Vayalapalli
Jennifer
J
Casarella
Richard
R
Amar
Karen
K
Drexler
D002047:Buprenorphine / Q000627:therapeutic use*; D003932:Heroin; D006556:Heroin Dependence / Q000188:drug therapy*; D006801:Humans; D008691:Methadone / Q000627:therapeutic use; D009271:Naltrexone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000534:rehabilitation; D016032:Randomized Controlled Trials as Topic; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy* / Q000534:rehabilitation
D009292:Narcotic Antagonists; D009294:Narcotics; D002047:Buprenorphine; D009271:Naltrexone; D003932:Heroin; D008691:Methadone