title: Opioid agonist treatment for pharmaceutical opioid dependent people.
abstract: BACKGROUND
  There are increasing concerns regarding pharmaceutical opioid harms including overdose and dependence, with an associated increase in treatment demand. People dependent on pharmaceutical opioids appear to differ in important ways from people who use heroin, yet most opioid agonist treatment research has been conducted in people who use heroin.
  
  
  OBJECTIVE
  To assess the effects of maintenance agonist pharmacotherapy for the treatment of pharmaceutical opioid dependence.
  
  
  METHODS
  The search included the Cochrane Drugs and Alcohol Group's Specialised Register of Trials; the Cochrane Central Register of Controlled Trials (CENTRAL, 2015, Issue 5); PubMed (January 1966 to May 2015); EMBASE (Ovid) (January 1974 to May 2015); CINAHL (EBSCOhost) (1982 to May 2015); ISI Web of Science (to May 2014); and PsycINFO (Ovid) (1806 to May 2014).
  
  
  METHODS
  We included randomised controlled trials examining maintenance opioid agonist treatments that made the following two comparisons:1. full opioid agonists (methadone, morphine, oxycodone, levo-alpha-acetylmethadol (LAAM), or codeine) versus different full opioid agonists or partial opioid agonists (buprenorphine) for maintenance treatment and2. full or partial opioid agonist maintenance versus placebo, detoxification only, or psychological treatment (without opioid agonist treatment).
  
  
  METHODS
  We used standard Cochrane methodological procedures.
  
  
  RESULTS
  We identified six randomised controlled trials that met inclusion criteria (607 participants).We found moderate quality evidence from two studies of no difference between methadone and buprenorphine in self reported opioid use (risk ratio (RR) 0.37, 95% confidence interval (CI) 0.08 to 1.63) or opioid positive urine drug tests (RR 0.81, 95% CI 0.56 to 1.18). There was low quality evidence from three studies of no difference in retention between buprenorphine and methadone maintenance treatment (RR 0.69, 95% CI 0.39 to 1.22). There was moderate quality evidence from two studies of no difference between methadone and buprenorphine on adverse events (RR 1.10, 95% CI 0.64 to 1.91).We found low quality evidence from three studies favouring maintenance buprenorphine treatment over detoxification or psychological treatment in terms of fewer opioid positive urine drug tests (RR 0.63, 95% CI 0.43 to 0.91) and self reported opioid use in the past 30 days (RR 0.54, 95% CI 0.31 to 0.93). There was no difference on days of unsanctioned opioid use (standardised mean difference (SMD) -0.31, 95% CI -0.66 to 0.04). There was moderate quality evidence favouring buprenorphine maintenance over detoxification or psychological treatment on retention in treatment (RR 0.33, 95% CI 0.23 to 0.47). There was moderate quality evidence favouring buprenorphine maintenance over detoxification or psychological treatment on adverse events (RR 0.19, 95% CI 0.06 to 0.57).The main weaknesses in the quality of the data was the use of open-label study designs.
  
  
  CONCLUSIONS
  There was low to moderate quality evidence supporting the use of maintenance agonist pharmacotherapy for pharmaceutical opioid dependence. Methadone or buprenorphine appeared equally effective. Maintenance treatment with buprenorphine appeared more effective than detoxification or psychological treatments.Due to the overall low to moderate quality of the evidence and small sample sizes, there is the possibility that the further research may change these findings.
authors.affiliation: National Drug and Alcohol Research Centre, UNSW, Building R3, 22 - 32 King Street, Randwick, NSW, Australia, 2031.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Nielsen
authors.forename: Briony
authors.initials: B
authors.lastname: Larance
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
authors.forename: Linda
authors.initials: L
authors.lastname: Gowing
authors.forename: Chyanne
authors.initials: C
authors.lastname: Kehler
authors.forename: Nicholas
authors.initials: N
authors.lastname: Lintzeris
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use; D002047:Buprenorphine / Q000627:therapeutic use*; D006801:Humans; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D063487:Prescription Drug Misuse; D016032:Randomized Controlled Trials as Topic
chemical_list: D000701:Analgesics, Opioid; D009294:Narcotics; D002047:Buprenorphine; D008691:Methadone