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Abstract

Background: Prior systematic reviews have compared the relative effectiveness of buprenorphine (BUP), methadone (MET) and other medications and treatments for opioid use disorder (OUD). The results suggest BUP is highly effective for reducing illicit opioid use and retaining people in treatment. The current review extends these prior reviews by synthesizing research, which compares BUP and buprenorphine and naloxone (BUP/NX) to several treatments in addition to MET on several primary and secondary outcomes.
Method: Literature searches were conducted using nine databases. Articles were limited to quantitative reports of studies conducted with adult human subjects in an outpatient, non-residential treatment settings in the United States, in peer-reviewed journals between January 1, 2001 and May 31, 2017, and written in English. Search strategies returned 1,981 articles, an additional eight articles were added through hand searching. Ninety-nine articles met inclusion criteria. After reading abstracts, 48 articles were excluded from the review. After reading the remaining 59 articles, another 36 were excluded. A total of 18 studies were included in the final analyses.
Results: MET was found to be superior to buprenorphine (BUP) in helping patients adhere to and remain in treatment, while BUP was superior to MET for achieving abstinence from opioids. BUP was found to be superior to behavioral treatment alone, extended release naltrexone (XR-NTX), an absence of any treatment, and placebo. Given the range of study designs and quality, populations, and outcomes examined, a meta-analysis was not feasible. The heterogeneity of included studies, however, permitted close examination of both the benefits and barriers of medication treatment for OUD in a range of patient populations and clinical settings, as well as the identification of gaps in both the research and treatment of OUD across a body of available literature.
Conclusion: Buprenorphine (BUP) is an effective treatment option for achieving abstinence from opioids, and with emerging treatment guidelines, may be easier to access than other forms of treatment. The review underscores much of the available research utilized protocols that are inconsistent with current clinical practice guidelines. Further, flaws in research designs make it difficult for providers to determine the best medication treatment in order to improve outcomes. Future research is necessary to determine the effectiveness of BUP when administered According to the most current protocols.

Keywords: Systematic review; Buprenorphine; Methadone; Treatment; Research; Practice