This study evaluated buprenorphine maintenance compared to placebo and methadone maintenance in the management of opioid dependence.
We include 31 trials (5430 participants), the quality of evidence varied from high to moderate quality. There is high quality of evidence that buprenorphine was superior to placebo medication in retention of participants in treatment at all doses examined. Specifically, buprenorphine retained participants better than placebo: at low doses (2 ‐ 6 mg), 5 studies, 1131 participants, risk ratio (RR) 1.50; 95% confidence interval (CI) 1.19 to 1.88; at medium doses (7 ‐ 15 mg), 4 studies, 887 participants, RR 1.74; 95% CI 1.06 to 2.87; and at high doses (≥ 16 mg), 5 studies, 1001 participants, RR 1.82; 95% CI 1.15 to 2.90;. however, there is moderate quality of evidence that only high‐dose buprenorphine (≥ 16 mg) was more effective than placebo in suppressing illicit opioid use measured by urinalysis in the trials, 3 studies, 729 participants, standardized mean difference (SMD) ‐1.17; 95% CI ‐1.85 to ‐0.49, Notably, low‐dose, (2 studies, 487 participants, SMD 0.10; 95% CI ‐0.80 to 1.01), and medium‐dose, (2 studies, 463 participants, SMD ‐0.08; 95% CI ‐0.78 to 0.62) buprenorphine did not suppress illicit opioid use measured by urinalysis better than placebo. There is high quality of evidence that buprenorphine in flexible doses adjusted to participant need, was less effective than methadone in retaining participants, 5 studies, 788 participants, RR 0.83: 95% CI 0.72 to 0.95. For those retained in treatment, no difference was observed in suppression of opioid use as measured by urinalysis, 8 studies, 1027 participants, SMD ‐0.11; 95% CI ‐0.23 to 0.02 or self-report, 4 studies, 501 participants, SMD ‐0.11; 95% CI ‐0.28 to 0.07, with moderate quality of evidence. (Published abstract provided)