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Buprenorphine for Opioid Use Disorder: A Review of Comparative Clinical Effectiveness, Safety, Cost-Effectiveness, and Guidelines

Last updated: April 24, 2019
Project Number: RC1092-000
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 (BUP-NAL) formulations versus other buprenorphine formulations for the treatment of opioid use disorder (OUD)?
  2. What is the clinical evidence regarding the safety of various buprenorphine or BUP-NAL formulations for the treatment of OUD?
  3. What is the cost-effectiveness of various buprenorphine or BUP-NAL formulations for the treatment of OUD?
  4. What are the evidence-based guidelines regarding the use of various buprenorphine or BUP-NAL formulations for the treatment of OUD?

Key Message

Two relevant systematic reviews, three randomized controlled trials (in four publications), six non-randomized studies, and two economic evaluations were identified regarding the clinical effectiveness, safety, and cost-effectiveness of various buprenorphine formulations for the treatment of OUD.Though there were some instances where specific formulations of buprenorphine demonstrated statistically significant improvements in outcomes of interest compared to other formulations, no clear patterns emerged regarding the comparative clinical effectiveness of buprenorphine for the treatment of OUD. The economic evaluation concluded that buprenorphine implant did not provide cost-effective benefit over generic sublingual buprenorphine-naloxone (BUP-NAL). The second economic evaluation reported that implantable buprenorphine was cost-effective compared to sublingual buprenorphine. It remains uncertain whether the findings of the reviewed literature are generalizable to the Canadian population as all of the included studies were conducted outside of Canada.Two evidence-based guidelines were identified regarding the use of various buprenorphine formulations for the treatment of OUD. One guideline recommends BUP-NAL as a first-line therapy for individuals who require opioid agonist treatment (strong recommendation based on high quality evidence). The second guideline recommends offering either BUP-NAL or methadone, while considering patient preferences, for individuals with OUD (strong recommendation). The limitations of the included studies, such as several with lack of blinding to treatment or few studies from Canadian settings, and of this report should be considered when interpreting the results.