Review of US clinical trials of buprenorphine

The partial agonist profile of buprenorphine makes it an ideal agent for the treatment of opioid addiction. Many studies have been carried out in the US and seven of these are reviewed here. Whilst a great deal of variability between methadone and buprenorphine dose-effects was seen, the evidence suggests that acute buprenorphine doses of 8-16 mg provided the maximal agonist effect; doses higher than this were no more effective which indicates a ceiling to its agonist profile. This is equivalent to the effect observed with approximately 60 mg methadone. Results from these studies have led to treatment guidelines that suggest that buprenorphine should be a first-line treatment option as a maintenance agent which also facilitates detoxification with minimal withdrawal, or allows a return to methadone with little problem if a higher agonist effect is required.