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Opioid addiction update 2008

Clinical bottom line

Buprenorphine had a significant effect on increasing abstinence from opioids in mostly short term trials, with an NNT of about 5. Almost 1 in 2 people dependent on opioids were abstinent at times up to six months with placebo.


Data

Information was available from five systematic reviews and meta-analyses (four Cochrane reviews) of opioid cessation studies, with information on over 3,400 participants with cessation rates over various times, with three of six months or longer, and tow of one to six months. There were a variety of interventions, including psychosocial and pharmacological, mainly methadone or buprenorphine. The reviews mainly used only properly randomised trials in patients with defined opioid addiction, used a mixture of non-use of opioid by measurement or retention in a programme to assess abstinence, and used placebo, in one review, maintenance methadone versus tapered withdrawal.

A summary of the reviews is available as a downloadable PDF (36kb).

Results

Table 1 shows the main results in terms percentage of abstinent patients with intervention and placebo, the relative benefit, and the NNT for one participant to be abstinent at six months who would not have been if treated with placebo. The order is by numbers of participants in the reviews Buprenorphine showed a reasonable effect, but with fewer than 1000 patents.

Table 1: Results of opioid cessation reviews, ordered by number of participants

 

Percent abstinent with
Intervention
Number of patients
Active
Placebo
Relative benefit
(95%CI)
NNT
(95% CI)
Psychosocial plus pharmacological
184
42
25
1.7 (1.1 to 2.6)
6.1 (3.4 to 35)
Methadone
1317
48
50
1.0 (0.8 to 1.7)
not calculated
Buprenorphine
884
63
41
1.7 (1.5 to 2.0)
4.6 (3.6 to 6.6)

 

Figure 1 shows the same information graphically, ordered by the proportion of patients abstinent at six months or longer with treatment.

The response for placebo varied between 25% and 50%, with an overall average cessation rate of 44% in 607 participants on placebo.

Comment

Buprenorphine had a significant effect on increasing abstinence from opioids in mostly short term trials. Almost 1 in 2 people dependent on opioids were abstinent at times up to six months with placebo.