Cited by 467Opioid Use Disorder TreatmentSubstance Abuse Treatment and OutcomesPain Management and Opioid Use

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1-year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: a randomised, placebo-controlled trial

Kakko, Johan, Svanborg, Kerstin Dybrandt, Kreek, Mary Jeanne, Heilig, Markus·2003·The Lancet

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Abstract

Background The partial opiate-receptor agonist buprenorphine has been suggested for treatment of heroin dependence, but there are few long-term and placebo-controlled studies of its effectiveness. We aimed to assess the 1-year efficacy of buprenorphine in combination with intensive psychosocial therapy for treatment of heroin dependence.Methods 40 individuals aged older than 20 years, who met DSM-IV criteria for opiate dependence for at least 1 year, but did not fulfil Swedish legal criteria for methadone maintenance treatment were randomly allocated either to daily buprenorphine (fixed dose 16 mg sublingually for 12 months; supervised daily administration for a least 6 months, possible take-home doses thereafter) or a tapered 6 day regimen of buprenorphine, thereafter followed by placebo. All patients participated in cognitive-behavioural group therapy to prevent relapse, received weekly individual counselling sessions, and submitted thrice weekly supervised urine samples for analysis to detect illicit drug use. Our primary endpoint was 1-year retention in treatment and analysis was by intention to treat.Findings 1-year retention in treatment was 75% and 0% in the buprenorphine and placebo groups, respectively (p=0.0001; risk ratio 58.7 [95% CI 7.4-467.4]). Urine screens were about 75% negative for illicit opiates, central stimulants, cannabinoids, and benzodiazepines in the patients remaining in treatment.Interpretation The combination of buprenorphine and intensive psychosocial treatment is safe and highly efficacious, and should be added to the treatment options available for individuals who are dependent on heroin.

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Authors: Kakko, J., Svanborg, K. D., Kreek, M. J., & Heilig, M.
Affiliations: Karolinska Institutet (SE)
Rockefeller University (US)
Corresponding author: Heilig, Markus
ORCID: Kreek, Mary Jeanne
Heilig, Markus
Venue: The Lancet
Publisher: Elsevier BV
Published: 2003-02
Volume: 361
Issue: 9358
Pages: 662-668
ISSN: 0099-5355 (ISSN-L)
0140-6736
DOI: 10.1016/s0140-6736(03)12600-1
OpenAlex: W2171737529
Cited by: 466
References: 32
Citations by year: 2026: 4 · 2025: 15 · 2024: 13 · 2023: 22 · 2022: 18 · 2021: 27 · 2020: 27 · 2019: 29 · 2018: 26 · 2017: 20 · 2016: 15 · 2015: 25 · 2014: 17 · 2013: 18 · 2012: 19
FWCI: 17.61
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: The Lancet (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health
U.S. Public Health Service (P-50-05130, K05 00049)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
Keywords: buprenorphine, heroin addiction, relapse prevention, treatment retention, social functioning, group cognitive behavioral therapy, psychosocial interventions, urine drug testing, opioid use disorder, sublingual buprenorphine
MeSH terms: Adult, Buprenorphine, Counseling, Female, Heroin Dependence, Humans, Male, Narcotic Antagonists, Psychotherapy, Group, Severity of Illness Index, Sweden, Treatment Outcome

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1-year retention and social function after buprenorphine-assisted relapse prevention treatment for heroin dependence in Sweden: a randomised, placebo-controlled trial

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