Higher Doses of Buprenorphine More Effectively Treat Opioid Craving Than Lower Doses

Longer retention in buprenorphine treatment (>6 months) has shown significant benefit for the treatment of opioid use disorder (OUD). Opioid craving may be one reason why individuals with OUD prematurely discontinue buprenorphine. This systematic review sought to describe how buprenorphine impacts self-reported opioid craving during initiation and ongoing treatment, and to compare opioid craving during receipt of buprenorphine with other medications for OUD.

• Opioid craving was lower among individuals receiving buprenorphine compared with placebo.
• Opioid craving was lower among individuals receiving buprenorphine at higher daily doses (>16mg), compared with those receiving lower daily doses.
• At three months, opioid craving was lower among individuals receiving 24–32mg of buprenorphine per day, compared with those receiving 8mg.
• Opioid craving was higher among individuals receiving buprenorphine compared with extended release naltrexone at 4–12 weeks of treatment, but at 24 weeks there were no differences in craving.
• In three studies, opioid craving was higher among individuals receiving buprenorphine compared with methadone, although higher doses of buprenorphine (32mg) were more effective than methadone at reducing opioid craving.
• In three studies, opioid craving was similar between individuals receiving buprenorphine and methadone.

Comments: Buprenorphine is an effective treatment for OUD, but individuals may experience opioid craving throughout their treatment. This systematic review shows the need for individuals to receive effective doses of buprenorphine to reduce opioid craving, which is a risk factor for return to opioid use. Opioid craving should be discussed with patients and treated as an important component of OUD care.

Melissa B. Weimer, DO, MCR

Reference: Baxley C, Borsari B, Reavis JV, et al. Effects of buprenorphine on opioid craving in comparison to other medications for opioid use disorder: a systematic review of randomized controlled trials. Addict Behav. 2023;139:107589.