Effect of buprenorphine dose on treatment outcome (2012)

The goal of this meta-analysis is to provide evidence based information about proper dosing for buprenorphine maintenance treatment to improve treatment outcome. To be selected for the review and inclusion in the meta-analysis, articles had to be randomized, controlled, or double-blind clinical trials, with buprenorphine as the study drug; the length of buprenorphine maintenance treatment had to be 3 weeks or longer; doses of buprenorphine had to be clearly stated; outcome measures had to include retention rates in buprenorphine treatment; outcome measures had to include illicit opioid use based on analytical determination of drugs of abuse in urine samples as outcome variables; and outcome measures had to include illicit cocaine use based on analytical determination of drugs of abuse in urine samples as outcome variables. Twenty-nine articles were excluded because they did not meet the inclusion criteria. The authors present the results of 21 articles that met inclusion criteria. The higher buprenorphine dose (16–32 mg per day) predicted better retention in treatment compared with the lower dose (less than 16 mg per day) (P = .009, R2 adjusted = 0.40), and the positive urine drug screens for opiates predicted dropping out of treatment (P = .019, R2 Adjusted = 0.40). Retention in treatment predicted less illicit opioid use (P = .033, R2 Adjusted = 0.36), and the positive urine drug screens for cocaine predicted more illicit opioid use (P = .021, R2 Adjusted = 0.36). Strong evidence exists based on 21 randomized clinical trials that the higher buprenorphine dose may improve retention in buprenorphine maintenance treatment.