Systematic Review to Assess the Efficacy of Buprenorphine Compared to Methadone as an Intervention for Opiate Dependency

Objective To assess the efficacy of buprenorphine compared to methadone as an intervention for opiate dependency. Data Sources: Electronic databases (MEDLINE, PubMed, PsychARTICLES, ProQuest, ScienceDirect, PsychINFO and Web of Science) Study Selection: Published studies from 2000–2014 relating to the efficacy of buprenorphine and methadone as maintenance treatments for opioid dependence. These studies included those that looked at retention and relapse rates, had quantitative evidence, and looked at both males and females. Eight out of 20 studies met these inclusion criteria and were included in the systematic review. Results The studies looked at efficacy in terms of retention and relapse rates. With regards to retention, three studies found methadone to be more effective than buprenorphine and the other five found no significant differences between the two groups. In terms of relapse measured by urinalysis, four studies found significantly lower positive opiate urine samples in the buprenorphine group and the other four found no significant difference between the two groups. Several problems have been identified with the research studies used. These include no long-term follow-up, potential for participation bias, varied number of participants across studies and the widely varied length of time studies were conducted over. Conclusion This systematic review hasn’t helped to resolve the conflicting research in this area. It has further been confounded by the inconsistencies of the research methodologies utilised which has created problems in making any meaningful comparisons. This highlights the need for a standardised shared approach to undertaking research in a way that promotes the opportunity for aggregating research data in a meaningful way. The urgency for this is even greater given the imminent introduction of a buprenorphine depot alternative which could potentially add another layer of clinical uncertainty if not resolved.