Buprenorphine is effective maintenance treatment for heroin dependence

Clinical question: 
How effective is buprenorphine in the maintenance treatment of heroin dependence?
Bottom line: 
Buprenorphine at medium (8-15mg) and high doses (16mg) can reduce heroin use compared with placebo, although it is less effective than methadone, especially if methadone is prescribed at adequate dose levels of between 60mg and 120mg per day.
Caveat: 
Buprenorphine given in flexible (variable) doses was statistically significantly less effective than methadone in retaining patients in treatment, but no different in suppression of opioid use for those who remained in treatment.
Context: 
Buprenorphine is a partial opioid agonist which is not as powerful as heroin or methadone. It has a longer half-life (24-37 hours) than methadone (22-25 hours), and can therefore be taken once every 2 days. Buprenorphine is offered alongside methadone for maintenance treatment of heroin dependence in programmes throughout the UK, Europe and Australia, but not yet in New Zealand.
Review CD#: 
CD002207
PEARLS No: 
111
Date: 
August, 2008
Authored by: 
Brian R McAvoy