Table.
GRADE evaluation of interventions for opioid dependence.
| Important outcomes | Retention in treatment, opioid misuse, withdrawal rates, relapse rates, mortality, and adverse effects | ||||||||
| Number of studies (participants) | Outcome | Comparison | Type of evidence | Quality | Consistency | Directness | Effect size | GRADE | Comment |
| What are the effects of drug treatments for stabilisation (maintenance) in people with opioid dependence? | |||||||||
| 2 (at least 487) | Retention in treatment | Buprenorphine v placebo | 4 | 0 | +1 | 0 | 0 | High | Consistency point added for positive dose response |
| 2 (at least 487) | Opioid misuse | Buprenorphine v placebo | 4 | 0 | +1 | 0 | 0 | High | Consistency point added for positive dose response |
| 1 (92) | Retention in treatment | Different frequencies of buprenorphine compared with each other | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| 1 (92) | Opioid misuse | Different frequencies of buprenorphine compared with each other | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and incomplete reporting of results |
| At least 6 RCTs (at least 1013) | Retention in treatment | Methadone v no opioid-replacement therapy | 4 | 0 | 0 | –1 | 0 | Moderate | Directness point deducted for large variation in study duration and design |
| At least 7 RCTs (at least 1013) | Opioid misuse | Methadone v no opioid-replacement therapy | 4 | 0 | 0 | –1 | 0 | Moderate | Directness point deducted for large variation in study duration and design |
| 3 (435) | Mortality | Methadone v no opioid-replacement therapy | 4 | 0 | 0 | –1 | 0 | Moderate | Directness point deducted for large variation in study duration and design |
| 3 (237) | Opioid misuse | High-dose methadone v lower-dose methadone | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for incomplete reporting of results. Directness point deducted for uncertainty about timing and method of measuring abstinence |
| 7 (at least 976) | Retention in treatment | Buprenorphine v methadone | 4 | 0 | –1 | 0 | 0 | Moderate | Consistency point deducted for heterogeneity among RCTs |
| 6 (at least 837) | Opioid misuse | Buprenorphine v methadone | 4 | 0 | –1 | 0 | 0 | Moderate | Consistency point deducted for heterogeneity among RCTs |
| What are the effects of drug treatments for withdrawal in people with opioid dependence? | |||||||||
| 3 (156) | Withdrawal rates | Buprenorphine v methadone | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 8 (760) | Withdrawal rates | Buprenorphine v clonidine | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for incomplete reporting |
| 1 (17) | Withdrawal rates | Buprenorphine v oxazepam | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (22) | Withdrawal rates | Methadone v placebo | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 11 (748) | Withdrawal rates | Methadone v any other pharmacological treatments | 4 | 0 | 0 | –1 | 0 | Moderate | Directness point deducted for uncertainty about comparators |
| 5 (237) | Withdrawal rates | Methadone v other opioid agonists | 4 | 0 | –1 | 0 | 0 | Moderate | Consistency point deducted for conflicting results |
| 1 (24) | Withdrawal rates | Methadone v chlordiazepoxide | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| At least 9 RCTs (at least 612) | Withdrawal rates | Alpha2-adrenoceptor agonists v methadone | 4 | 0 | 0 | –1 | 0 | Moderate | Directness point deducted for diverse study designs, assessment and reporting of outcomes |
| 1 (50) | Withdrawal rates | Lofexidine v clonidine | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 RCT (210) | Withdrawal rates | Lofexidine v buprenorphine | 4 | –1 | 0 | –1 | 0 | Low | Quality point deducted for incomplete reporting of results. Directness point deducted for unclear measurement of outcomes |
| 1 (101) | Withdrawal rates | Ultra-rapid withdrawal v standard withdrawal | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (101) | Opioid misuse | Ultra-rapid withdrawal v standard withdrawal | 4 | –2 | 0 | 0 | 0 | Low | Quality points deducted for sparse data and for incomplete reporting of results |
| What are the effects of drug treatments for relapse prevention in people with opioid dependence? | |||||||||
| 1 (50) | Relapse rates | Naltrexone alone v placebo | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 3 (134) | Opioid misuse | Naltrexone alone v placebo | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 1 (35) | Relapse rates | Naltrexone (with psychosocial treatment) v placebo (with psychosocial treatment) | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
| 2 (115) | Opioid misuse | Naltrexone (with psychosocial treatment) v placebo (with psychosocial treatment) | 4 | –1 | 0 | 0 | 0 | Moderate | Quality point deducted for sparse data |
Type of evidence: 4 = RCT; 2 = Observational; Consistency: similarity of results across studies; Directness: generalisability of population or outcomes.