Begin main content

Buprenorphine-Naloxone Tablet Versus Methadone for the Treatment of Patients with Opioid Use Disorder: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Last updated: July 31, 2019
Project Number: RC1150-000
Product Line: Rapid Response
Research Type: Drug
Report Type: Summary with Critical Appraisal
Result type: Report

Question

  1. What is the clinical effectiveness of buprenorphine-naloxone tablets compared with methadone for the treatment of patients with opioid use disorder?
  2. What is the cost-effectiveness of buprenorphine-naloxone tablets compared with methadone for the treatment of patients with opioid use disorder?
  3. What are the evidence-based guidelines associated with the use of buprenorphine-naloxone for the treatment of patients with opioid use disorder?
  4. What are the evidence-based guidelines associated with the use of methadone for the treatment of patients with opioid use disorder?

Key Message

Four relevant systematic reviews, one randomized controlled trial, and one non-randomized study were identified regarding the clinical effectiveness of buprenorphine-naloxone (BUP-NAL) as compared to methadone for the treatment of opioid use disorder (OUD). No relevant economic evaluations were identified.No clear patterns emerged regarding the comparative effectiveness of BUP-NAL and methadone. It remains uncertain whether the findings of the reviewed literature are generalizable to the Canadian population as many of the included studies were conducted outside of Canada.Six reports representing four guidelines were identified regarding the use of BUP-NAL or methadone for the treatment of OUD. Four guidelines provide strong recommendations for the use of BUP-NAL as treatment initiation or maintenance. Two guidelines are specific to pregnant people and offer conflicting recommendations.The limitations of the included studies, such as lack of blinding to treatment or few studies from Canadian settings, should be considered when interpreting the results.