Buprenorphine implants are at least as effective as sublingual buprenorphine as a maintenance treatment for opioid dependence, according to a noninferiority trial in JAMA.
Roughly 175 adults who were clinically stable on sublingual buprenorphine were randomized to receive four buprenorphine implants plus sublingual placebo or four placebo implants plus sublingual buprenorphine. The primary endpoint — the proportion of participants with at least 4–6 months without illicit opioid use (assessed by self-report and urine testing) — was 96% with buprenorphine implants and 88% with sublingual buprenorphine.
The results not only demonstrated that buprenorphine implants were noninferior to sublingual treatment, but also suggested they might be superior. Editorialists call for further research “to confirm this potential superiority and determine whether this finding is related to treatment adherence.” Additionally, they and the authors note that the findings have limited generalizability, as the majority of the participants were white, employed, and dependent on prescription opioids.