This review examines the evidence for the use of buprenorphine compared with methadone for opioid dependence under the following headings:

• About opioid dependence

• About buprenorphine

• Clinical trial evidence – maintenance

• Clinical trial evidence – detoxification

• Unwanted effects

• Contraindications and precautions

• Cost

The DTB concludes “For maintenance treatment of opioid dependence, methadone is superior to buprenorphine for retention in treatment and reduction in illicit opioid use. It also costs less and is easier to supervise, and so should generally be prescribed as the first choice. Buprenorphine can be considered when methadone is ineffective or associated with unwanted effects. For detoxification, the effectiveness of the two drugs is similar, but buprenorphine may be associated with less severe withdrawal symptoms than methadone, and may be useful for people who have a realistic prospect of becoming drug-free. The effects of buprenorphine pleateau as the dose increases and this limits the usefulness of the drug in people dependent on high doses of opioids.”