title: The World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the biological treatment of substance use and related disorders. Part 2: Opioid dependence.
abstract: OBJECTIVE
  To develop evidence-based practice guidelines for the pharmacological treatment of opioid abuse and dependence.
  
  
  METHODS
  An international task force of the World Federation of Societies of Biological Psychiatry (WFSBP) developed these practice guidelines after a systematic review of the available evidence pertaining to the treatment of opioid dependence. On the basis of the evidence, the Task Force reached a consensus on practice recommendations, which are intended to be clinically and scientifically meaningful for physicians who treat adults with opioid dependence. The data used to develop these guidelines were extracted primarily from national treatment guidelines for opioid use disorders, as well as from meta-analyses, reviews, and publications of randomized clinical trials on the efficacy of pharmacological and other biological treatments for these disorders. Publications were identified by searching the MEDLINE database and the Cochrane Library. The literature was evaluated with respect to the strength of evidence for efficacy, which was categorized into one of six levels (A-F).
  
  
  RESULTS
  There is an excellent evidence base supporting the efficacy of methadone and buprenorphine or the combination of buprenorphine and naloxone for the treatment of opioid withdrawal, with clonidine and lofexidine as secondary or adjunctive medications. Opioid maintenance with methadone and buprenorphine is the best-studied and most effective treatment for opioid dependence, with heroin and naltrexone as second-line medications.
  
  
  CONCLUSIONS
  There is enough high quality data to formulate evidence-based guidelines for the treatment of opioid abuse and dependence. This task force report provides evidence for the efficacy of a number of medications to treat opioid abuse and dependence, particularly the opioid agonists methadone or buprenorphine. These medications have great relevance for clinical practice.
authors.affiliation: Department of Psychiatry, Ludwig-Maximilian University, Munich, Germany. Michael.Soyka@privatklinik-meiringen.ch
authors.forename: Michael
authors.initials: M
authors.lastname: Soyka
authors.forename: Henry R
authors.initials: HR
authors.lastname: Kranzler
authors.forename: Wim
authors.initials: W
authors.lastname: van den Brink
authors.forename: John
authors.initials: J
authors.lastname: Krystal
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Möller
authors.forename: Siegfried
authors.initials: S
authors.lastname: Kasper
mesh_terms: D000328:Adult; D001189:Aryl Hydrocarbon Hydroxylases / Q000378:metabolism; D002047:Buprenorphine / Q000008:administration & dosage / Q000009:adverse effects; D065702:Cytochrome P-450 CYP2B6; D019389:Cytochrome P-450 CYP2D6 / Q000378:metabolism; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D014644:Genetic Variation; D006801:Humans; D008691:Methadone / Q000008:administration & dosage / Q000009:adverse effects; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D009294:Narcotics / Q000009:adverse effects*; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000378:metabolism / Q000628:therapy*; D010089:Oxidoreductases, N-Demethylating / Q000378:metabolism; D011613:Psychotherapy; D011957:Receptors, Opioid / Q000235:genetics / Q000378:metabolism; D012944:Social Support; D059039:Standard of Care; D013375:Substance Withdrawal Syndrome / Q000628:therapy*
chemical_list: D009292:Narcotic Antagonists; D009294:Narcotics; D011957:Receptors, Opioid; D002047:Buprenorphine; D001189:Aryl Hydrocarbon Hydroxylases; C585599:CYP2B6 protein, human; D065702:Cytochrome P-450 CYP2B6; D019389:Cytochrome P-450 CYP2D6; D010089:Oxidoreductases, N-Demethylating; D008691:Methadone