***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Rationale Buprenorphine may be a useful alternative option to methadone in addicts . Opioids can produce severe changes in the immune system . Objectives The objectives of this study are to compare the effect of sublingual buprenorphine and methadone on the immune system and to compare the two substances on the drying-out program compliance . Methods We studied 62 r and omized out patients for a period of 12 months . Subjects ( 55 males and 7 females ; mean age 25±4 years ; average history of heroin abuse being 2 years ) on maintenance treatment were assigned in two groups ( A and B ) . Methadone chloride ( medium dose 100 mg/day ) was administered to group A , whereas group B received sublingual buprenorphine ( 32.40±2.8 mg/day ) . Urine toxicological screening , plasma levels of TNF-alpha interleukin-1 , interleukin-beta , lymphocyte CD14 and a self-rating depression question naire were measured . Results Urine screening was negative for opiates in 17.6 % of group A and in 10.7 % of group B ( p<0.001 ; r=0.62 ) . Depression score was 62±2 in group A and 55±3 in group B ( p<0.01 ) . Cytokine and CD14 revealed higher concentrations both in groups A and B without significant differences ( p>0.05 ) between the two groups . Conclusions The effects of buprenorphine and methadone tested on the immune system were overlapping in our patients . The elevated cytokine levels observed may suggest that the two drugs stimulate immunologic hyperactivation of an immune system that was formerly inhibited by heroin . Furthermore , our data suggest that buprenorphine can be a valid alternative to methadone in maintenance treatment of chronic heroin abuse and referred a marked decline in depression BACKGROUND Heroin-assisted treatment has been found to be effective for people with severe opioid dependence who are not interested in or do poorly on methadone maintenance . AIMS To study heroin-assisted treatment in people on methadone who continue intravenous heroin and in those who are heroin dependent but currently not in treatment . METHOD In an open-label multicentre r and omised controlled trial , 1015 people with heroin dependence received a variable dose of injectable heroin ( n=515 ) or oral methadone ( n=500 ) for 12 months . Two response criteria , improvement of physical and /or mental health and decrease in illicit drug use , were evaluated in an intent-to-treat analysis . RESULTS Retention was higher in the heroin ( 67.2 % ) than in the methadone group ( 40.0 % ) and the heroin group showed a significantly greater response on both primary outcome measures . More serious adverse events were found in the heroin group , and were mainly associated with intravenous use . CONCLUSIONS Heroin-assisted treatment is more effective for people with opioid dependence who continue intravenous heroin while on methadone maintenance or who are not enrolled in treatment . Despite a higher risk , it should be considered for treatment resistance under medical supervision Methadone medical maintenance ( MMM ) reduces the reporting schedule for stable and well-functioning methadone maintenance patients to once a month , with counseling provided by medical staff . We report on the 12-month outcomes of 92 highly stable methadone maintenance patients r and omly assigned to one of three study conditions : routine care , MMM at the methadone maintenance program , and MMM at a physician 's office . Methadone medical maintenance patients received a 28-day supply of methadone , whereas  routine care patients  received five or six take-home methadone doses each week . All patients performed a medication recall once a month and su bmi tted two urine sample s each month . An adaptive stepped-care system of treatment intensification was used for patients who failed recall or who had drug-positive urine specimens . Seventy-seven patients completed the 12-month study period .  Dropout was caused primarily by problems with h and ling methadone and disliking the recall frequency . There were low rates of drug use or failed medication recall . Treatment satisfaction was high in all groups , but the MMM patients initiated more new employment or family/social activities than did routine care patients over the study period . The stepped-care approach was well tolerated and matched patients to an appropriate step of service within a continuum of treatment intensity Abstract Background Buprenorphine dependence is a relatively novel addiction . Aims To compare the treatment outcome in three groups over 12-weeks of treatment . Methods Two hundred and four intravenous (IV)-buprenorphine-dependent patients were r and omised into three groups . Subjects received 50 mg oral methadone tablet , or 5 mg sublingual buprenorphine tablet , or 50 mg oral naltrexone , and a weekly 30-minute clinical counselling session . Results The majority ( 80 % ) had a history of opium or heroin dependency before they were introduced to IV buprenorphine . The main source of buprenorphine for misusers was street sale ( 91 % ) . The mean duration of buprenorphine dependence was 1.9 years and the mean dose per day was 3.9 ampoules ( 1 ampoule contains 0.3 mg of buprenorphine in 1ml ) . Overall 59 % of the patients completed the 12-week study . Retention in the 50 mg methadone group was significantly better than the 5 mg dose buprenorphine group ( p=0.001 ) and the 50 mg dose naltrexone group ( p=0.000 ) . Retention in the 5 mg buprenorphine group was significantly better than the 50 mg naltrexone dose group ( p=0.000 ) . Conclusions These results support the efficacy and safety of oral methadone and sublingual buprenorphine tablets for injection buprenorphine-dependent patients 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 aim ed 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 r and omly 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 su bmi tted thrice weekly supervised urine sample s 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 CONTEXT Effective alternatives to long waiting lists for entry into methadone hydrochloride maintenance treatment are needed to reduce the complications of continuing heroin dependence and to increase methadone treatment entry . OBJECTIVE To compare the effectiveness of interim methadone maintenance with that of the usual waiting list condition in facilitating methadone treatment entry and reducing heroin and cocaine use and criminal behavior . DESIGN R and omized , controlled , clinical trial using 2 conditions , with treatment assignment on a 3:2 basis to interim maintenance-waiting list control . SETTING A methadone treatment program in Baltimore . PARTICIPANTS A total of 319 individuals meeting the criteria for current heroin dependence and methadone maintenance treatment . INTERVENTIONS Participants were r and omly assigned to either interim methadone maintenance , consisting of an individually determined methadone dose and emergency counseling only for up to 120 days , or referral to community-based methadone treatment programs . MAIN OUTCOME MEASURES Entry into comprehensive methadone maintenance therapy  at 4 months from baseline ; self-reported days of heroin use , cocaine use , and criminal behavior ; and number of urine drug test results positive for heroin and cocaine at the follow-up interview conducted at time of entry into comprehensive methadone treatment ( or at 4 months from baseline for participants who did not enter regular treatment ) . RESULTS Significantly more participants assigned to the interim methadone maintenance condition entered comprehensive methadone maintenance treatment by the 120th day from baseline ( 75.9 % ) than those assigned to the waiting list control condition ( 20.8 % ) ( P<.001 ) . Overall , in the past 30 days at follow-up , interim participants reported significantly fewer days of heroin use ( P<.001 ) , had a significant reduction in heroin-positive drug test results ( P<.001 ) , reported spending less money on drugs ( P<.001 ) , and received less illegal income ( P<.02 ) than the waiting list participants . CONCLUSION Interim methadone maintenance results in a substantial increase in the likelihood of entry into comprehensive treatment , and is an effective means of reducing heroin use and criminal behavior among opioid-dependent individuals awaiting entry into a comprehensive methadone treatment program This study a ) compared the effects of buprenorphine versus methadone maintenance on benzodiazepine and alcohol use and b ) evaluated the prognostic significance of gender and psychopathology and their interaction with maintenance treatment . Eighty male and 36 female patients were r and omly assigned to daily sublingual buprenorphine ( 4 or 12 mg ) or oral methadone ( 20 or 65 mg ) . Maintenance medication was not associated with significant differences in alcohol or benzodiazepine use . Rates of abstinence from illicit opioids were significantly higher for females , within the buprenorphine 4-mg group , females also had significantly better retention , lower rates of opioid-positive urine sample s , and higher rates of abstinence from illicit opioids . Lifetime sedative dependence was associated with significantly better retention , decreased rates of cocaine-positive urine sample s , and increased rates of cocaine abstinence ; among buprenorphine- but not methadone-maintained patients , it was also associated with increased rates of abstinence from illicit opioids BACKGROUND Expansion of access to effective treatments for heroin dependence is a worldwide health priority that will also reduce HIV transmission . We compared the efficacy of naltrexone , buprenorphine , and no additional treatment , in patients receiving detoxification and subsequent drug counselling , for maintenance of heroin abstinence , prevention of relapse , and reduction of HIV risk behaviours . METHODS 126 detoxified heroin-dependent patients , from an outpatient research clinic and detoxification programme in Malaysia , were r and omly assigned by a computer-generated r and omisation sequence to 24 weeks of manual-guided drug counselling and maintenance with naltrexone ( n=43 ) , buprenorphine ( n=44 ) , or placebo ( n=39 ) . Medications were administered on a double-blind and double-dummy basis . Primary outcomes , assessed by urine testing three times per week , were days to first heroin use , days to heroin relapse ( three consecutive opioid-positive urine tests ) , maximum consecutive days of heroin abstinence , and reductions in HIV risk behaviours over 6 months . The study was terminated after 22 months of enrolment because buprenorphine was shown to have greater efficacy in an interim safety analysis . Analysis was by intention to treat . This study is registered with Clinical Trials.gov , number NCT00383045 . FINDINGS We observed consistent , linear contrasts in days to first heroin use ( p=0.0009 ) , days to heroin relapse ( p=0.009 ) , and maximum consecutive days abstinent ( p=0.0007 ) , with all results best for buprenorphine and worst for placebo . Buprenorphine was associated with greater time to first heroin use than were naltrexone ( hazard ratio 1.87 [ 95 % CI 1.21 - 2.88 ] ) or placebo ( 2.02 [ 1.29 - 3.16 ] ) . With buprenorphine , we also recorded significantly greater time to heroin relapse ( 2.17 [ 1.38 - 3.42 ] ) , and maximum consecutive days abstinent than with placebo ( mean days 59 [ 95 % CI 43 - 76 ] vs 24 [ 13 - 35 ] ; p=0.003 ) ; however , for these outcomes , differences between buprenorphine and naltrexone were not significant . Differences between naltrexone and placebo were not significant for any outcomes . HIV risk behaviours were significantly reduced from baseline across all three treatments ( p=0.003 ) , but the reductions did not differ significantly between the three groups . INTERPRETATION Our findings lend support to the widesp 
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The majority of patients agreed that abstinence from opioids was a primary goal in their treatment , although they also stressed goals under-reported in clinical trials .
Conclusions There is inconsistency in the measures used to evaluate the effectiveness of OSATs .