Buprenorphine Implants as Effective as Sublingual for Opioid Dependence

Buprenorphine implants may be as effective as sublingual buprenorphine treatment, according to the results of a new clinical trial.

Opioid abuse is a growing concern in the United States. Even though current treatment may be successful in the short term, little research has explored treatment options for long-term remission of opioid abuse.
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To examine other options, the researchers conducted a randomized study of 177 outpatients who were clinically stable and were receiving treatment at 21 sites in the United States from June 26, 2014, through May 18, 2015.

Patients were randomly assigned to receive either sublingual buprenorphine plus 4 placebo implants or sublingual placebo plus four 80-mg buprenorphine hydrochloride implants.

The researchers’ primary end point was to determine the difference of responders between groups. Responders were categorized as patients who had opioid-negative urine tests for 4 or fewer months and had negative self-reports.

After a 6-month follow-up, there was an 8.8% difference between groups.

Of the 84 patients receiving buprenorphine implants, 81 were responders, and 72 maintained opioid abstinence. In this group, 48.3% had non–implant-related adverse events, and 23.0% had implant-related adverse events.

Of the 89 patients receiving sublingual buprenorphine, 78 were responders, and 64 maintained opioid abstinence. In this group, 52.8% had non–implant-related adverse events, and 13.5% had implant-related adverse events.

“Among adults with opioid dependence maintaining abstinence with a stable dose of sublingual buprenorphine, the use of buprenorphine implants compared with continued sublingual buprenorphine did not result in an inferior likelihood of remaining a responder,” the researchers concluded.

“However, the study population had an exceptionally high response rate in the control group, and further studies are needed in broader populations to assess the efficacy in other settings.”

—Amanda Balbi

Reference:

Rosenthal RN, Lofwall MR, Kim S, Chen M, Beebe KL, Vocci FJ; PRO-814 Study Group. Effect of buprenorphine implants on illicit opioid use among abstinent adults with opioid dependence treated with sublingual buprenorphine: a randomized clinical trial [published online July 19, 2016]. JAMA. doi: 10.1001/jama.2016.9382.