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This entry is our analysis of a review or synthesis of research findings added to the Effectiveness Bank. The original review was not published by Findings; click Title to order a copy. Free reprints may be available from the authors – click prepared e-mail. Links to other documents. Hover over for notes. Click to highlight passage referred to. Unfold extra text Unfold supplementary text The Summary conveys the findings and views expressed in the review.

Title and link for copying Comment/query to editor

Heroin anticraving medications: a systematic review.

Fareed A., Vayalapalli S., Casarella J. et al.
American Journal of Drug and Alcohol Abuse: 2010, 36(6), p. 332–341.
Unable to obtain a copy by clicking title? Try asking the author for a reprint by adapting this prepared e-mail or by writing to Dr Fareed at ayman.fareed@va.gov.

The observation that craving can precipitate relapse to heroin use or drop-out even among methadone-maintained patients led to this search for evidence that other medications can help suppress the urge to use; buprenorphine had the most extensive positive research record to date.

Summary Background Heroin craving is a trigger for relapse and dropping out of treatment. Methadone has been the standard medication for the management of heroin craving.

Objectives We explored the medication options other than methadone which may have heroin anti-craving properties.

Methods To be selected for the review, articles had to include outcome measures of the effect of the studied medication on subjective and/or objective opiate craving and be of the following two types:
• randomised, controlled, and/or double-blind clinical trials (RCTs) examining the relationship between the studied medication and heroin craving;
• nonrandomised and observational studies (NRSs) examining the relationship between the studied medication and heroin craving.

Thirty-three articles were initially included in the review. Twenty-one were excluded because they did not meet the inclusion criteria. We present the results of 12 articles that met all the inclusion criteria.

Results Some new medications have been under investigation and seem promising for the treatment of opiate craving. Buprenorphine is the second most studied medication after methadone for its effect on opiate craving. At doses above 8mg daily, it seems very promising and practical for managing opiate craving in patients receiving long-term opioid maintenance treatment.

Conclusions and Scientific Significance In doses higher than 8mg daily, buprenorphine is an appropriate treatment for opiate craving. More research with rigorous methodology is needed to study the effect of buprenorphine on heroin craving. Also more studies are needed to directly compare buprenorphine and methadone with regard to their effects on heroin craving.

Last revised 18 January 2011

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