A major network meta-analysis of 95 trials found that heroin-assisted therapy and high-dose methadone dramatically improved treatment retention in patients with opioid use disorder (OUD), while buprenorphine led the pack for reducing opioid use. The findings, published in The Canadian Journal of Psychiatry, reinforce high-dose methadone as a first-line OUD treatment — but also flag the need for more research as the drug supply grows increasingly toxic.
A sweeping new systematic review and network meta-analysis published in The Canadian Journal of Psychiatry compared 13 pharmacologic and control interventions for opioid use disorder (OUD) across 95 randomized controlled trials involving over 26,600 participants. The bottom line? Different therapies shine in different ways — and no single treatment does it all.
When it came to keeping patients in treatment, heroin-assisted therapy was the standout, particularly for those who hadn't responded to standard care. High-dose methadone also showed strong retention benefits. But for actually reducing opioid use, buprenorphine — both high- and low-dose — came out ahead, showing meaningful improvements in abstinence rates versus placebo. No clear winners emerged for criminal activity, mortality, or overdose deaths, though the evidence for those outcomes was limited.
Key Takeaways:
Why it matters: With an increasingly toxic illicit drug supply driving overdose deaths, matching the right OUD treatment to the right patient has never been more critical. These findings give clinicians a clearer evidence base for individualized treatment decisions.
