Programs for the Reduction or Discontinuation of Opioids or Opioid Substitution Therapy: A Review of the Clinical Effectiveness

Key Message

Eighteen SRs were identified with a wide variability of quality of evidence and objectives. Buprenorphine, tapered doses of methadone, and alpha2-adrenergic agonists could be used in the management of opioid withdrawal. There was insufficient evidence to favor any specific pharmacological approach in the management of opium withdrawal. Among pharmacotherapy programs in opioid maintenance treatment, methadone and buprenorphine appeared to be equally effective, naltrexone implants may be offered as an alternative option, and supervised injectable heroin may be effective but less safe than methadone in maintenance treatment for refractory heroin addiction. The addition of certain psychosocial interventions to methadone or buprenorphine appeared to provide additional benefits in the maintenance treatment of opioid dependence. Cognitive behavioral therapy did not seem to have any additional effect. Buprenorphine treatment for pregnant people with opioid use disorder was associated better neonatal and parental outcomes compared to methadone treatment.