28 February 2003
Buprenorphine in conjunction with intensive psychosocial therapy is a safe, highly effective treatment for heroin dependence, a randomised placebo-controlled trial shows.
(Buprenorphine is a medication that can be given to people with heroin dependence who are seeking recovery for active drug addiction. It is administered as a tablet, often 3 times weekly on an ongoing basis.)
Buprenorphine — also known as ‘B’ or ‘Bup’ — had a one-year treatment retention rate of 75 per cent compared with 0 per cent for placebo (a dummy medication) plus 6 initial days of buprenorphine. All 40 participants received cognitive behavioural group therapy and weekly individual counselling, and gave urine samples 3 times weekly.
About 75 per cent of the urine samples from buprenorphine users were free of opiates and other illicit drugs.
This suggested treatment was effective in reducing heroin and other drug use, Swedish researchers noted (The Lancet 2003; 361: 662-68).
‘It shows the very high cost of the 'do nothing' option: 20 per cent on placebo were dead in 12 months compared with none on buprenorphine,’ said Dr Alex Wodak, the director of the alcohol and drug service at St Vincent's Hospital, Sydney.
While 90 per cent of over 33,000 Australians on maintenance pharmacotherapy for heroin dependence were prescribed methadone, the proportion being prescribed buprenorphine was rising rapidly, Dr Wodak said.
Compared with methadone, buprenorphine had a better safety record, less stigma attached to use, and was easier to withdraw from, he said.
People could also be managed with alternate daily or 3 times weekly dosing, compared to the daily dosing required in methadone maintenance therapy, making it an attractive option in detoxification.
However, he said methadone was easier to use, easier and faster to dispense, cheaper, known to be safe in pregnancy and lactation, and had better retention and probably better outcomes in severe dependence.
Schering Plough funded one author, and donated study medication.
Last Reviewed: 02 March 2003