Begin main content

Buprenorphine Formulations for the Treatment of Opioid Use Disorders: A Review of Comparative Clinical Effectiveness, Cost-Effectiveness and Guidelines

Last updated: July 31, 2017
Project Number: RC0908-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the comparative clinical effectiveness of various buprenorphine or buprenorphine-naloxone formulations for the treatment of opioid use disorders?
  2. What is the cost-effectiveness of various buprenorphine or buprenorphine-naloxone formulations for the treatment of opioid use disorders?
  3. What are the evidence-based guidelines regarding the use of various buprenorphine or buprenorphine-naloxone formulations for the treatment of opioid use disorders?

Key Message

There is a paucity of high quality, large-scale randomized controlled trials comparing clinically relevant outcomes of effectiveness between different buprenorphine formulations for the treatment of opioid use disorder. Results were assessed in five randomized controlled trials and three non-randomized studies. No systematic reviews comparing the various buprenorphine formulations were found. All the buprenorphine formulations examined in the selected studies showed a similar clinical response in patients with opioid use disorder, with significantly higher rates of abuse, misuse and diversion found in sublingual buprenorphine-naloxone tablet formulations. The use of buprenorphine implants was associated with high rates of treatment retention. The rates of adverse effects were low among buprenorphine formulations with no significant differences observed. Within the clinical studies which met inclusion criteria, all but two were industry-sponsored and there were limitations with respect to study design, clinically relevant outcomes and treatment duration.There was one economic evaluation which demonstrated cost-effectiveness of the use of buprenorphine implants over sublingual buprenorphine-naloxone film, with respect to clinical outcomes and lower costs from a societal perspective. However, results from this study should be interpreted with caution due to limitations in this study.There are no Canadian or American clinical practice guidelines identified which specifically compare and evaluate different formulations of buprenorphine for OUD. One Australian guideline was found which suggested the use of buprenorphine-naloxone sublingual film over tablets due to ease of supervision and potential decreased risk of diversion.