Buprenorphine: evidence for effectiveness

ENGLISH :
In all cases, opiate addiction is best treated by the use of opiate agonist agents. A maintenance regimen based on an opiate agonist leads to a gradual dwindling of the subjective effects due to street opiates, thanks to the blockade achieved by these agents on the receptors that are reached by heroin. Buprenorphine looms as the most useful of the latest generation of agonist agents for the treatment of opioid use disorders. It is equivalent to other opiates as regards retention rates and control of street opiate use. Apart from maintenance programmes for opiate addiction, buprenorphine has proved effective in short-term programmes for opiate detoxification. Buprenorphine treatment should be regarded as first-line in subjects with low levels of craving and low severity of addictive behaviours, as long as: 1) it is documented that low methadone doses produced complete and stable remission; or 2) after a period of ongoing abstinence in drug-free conditions, the patient has recently relapsed into use of street opiates, so that their tolerance threshold is presumably still low. For subjects, whose tolerance is unknown, or when anamnestic or objective elements suggest there may be a high tolerance threshold, or else in cases comprising a recent history of unresponsiveness to low dose methadone treatments (below 60 mg), methadone should be the first choice for the therapy of opiate addiction. Subjects who have proved to be refractory to buprenorphine, even at higher dosages, can reasonably be directed to a methadone treatment programme. (Author' s abstract)