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).
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