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Evidence summaries

Buprenorfine for the Management of Opioid Withdrawal

Buprenorphine is more effective than clonidine or lofexidine and of similar effectiveness to methadone for the management of opioid withdrawal. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 27 studies involving 3 048 participants. 12 studies compared buprenorphine with an alpha2-adrenergic agonist, clonidine (11 studies) or lofexidine (1 study); 6 compared buprenorphine with methadone; 1 compared buprenorphine with oxazepam; 7 compared different rates of buprenorphine dose reduction; 1 compared different starting doses of buprenorphine.

Relative to clonidine or lofexidine, buprenorphine is more effective in ameliorating the symptoms of withdrawal, patients treated with buprenorphine stay in treatment for longer (SMD 0.92, 95% CI 0.57 to 1.27; 5 trials, n=558), and are more likely to complete withdrawal treatment (RR 1.59, 95% CI 1.23 to 2.06; 12 trials, n= 1 264). There is no significant difference in the incidence of adverse effects, but drop-out due to adverse effects may be more likely with clonidine.

Severity of withdrawal is similar for buprenorphine and methadone, but withdrawal symptoms may resolve more quickly with buprenorphine. There is a trend towards completion of withdrawal treatment being more likely with buprenorphine relative to methadone (RR 1.04, 95% CI 0.91 to 1.20; 5 trials, n = 457).

    References

    • Gowing L, Ali R, White JM et al. Buprenorphine for managing opioid withdrawal. Cochrane Database Syst Rev 2017;(2):CD002025. [PubMed]

Primary/Secondary Keywords