Clinical Effectiveness of Opioid Substitution Treatment

Details

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Project Status:
Completed
Project Line:
Health Technology Review
Project Sub Line:
Rapid Review
Project Number:
RC1405-000 - RB1604-000

Question

  1. What is the clinical effectiveness of sustained-release oral morphine in opioid use disorder?
  2. What is the clinical effectiveness of oral hydromorphone in opioid use disorder?
  3. What is the clinical effectiveness of injectable hydromorphone or prescription diacetylmorphine in opioid use disorder?
  4. What is the clinical effectiveness of fentanyl patches or fentanyl buccal tablets in opioid use disorder?

Key Message

A preponderance of evidence identified in this review indicates a relative benefit in the clinical effectiveness of heroin-assisted treatment, injectable hydromorphone, or diacetylmorphine compared to methadone in patients with opioid use disorder. Most of the evidence in this review describing sustained-release oral morphine versus methadone shows no significant difference in measures of clinical effectiveness for patients with opioid use disorder. There is a lack of evidence reported in systematic reviews and randomized controlled trials describing the clinical effectiveness of oral hydromorphone, fentanyl patches, and fentanyl buccal tablets. Most of the evidence in this review, describing various forms of opioid substitution treatments, has been characterized as low quality and draws from the same several trials.